This document provides an overview of alcohol-related presentations to the emergency department. It discusses statistics on alcohol use and related illnesses. It covers the pharmacology of ethanol and examines acute intoxication, alcohol in trauma, alcohol withdrawal, chronic alcoholism and associated health problems, toxic alcohols, and Wernicke-Korsakoff syndrome. Hepatic disease, encephalopathy, varices, and other issues related to long-term alcohol use are also reviewed.
This document discusses the causes, examination, and approach to an unconscious patient. It lists various potential causes of unconsciousness including trauma, hypoxia, infection, hemorrhage, metabolic disturbances, organ failure, drugs, and more. It describes examining the patient's vital signs, neurological status including level of consciousness assessed by GCS, and potential pupil abnormalities. Key steps in management involve supporting life functions, diagnosing the cause through history, focused exam, and investigations, and then treating reversible causes.
The document discusses ethanol (ethyl alcohol) and its effects as an inebriant substance. It defines alcohol and its origins, describes its production and metabolism in the body, acute and chronic effects on health, signs of alcohol poisoning and withdrawal symptoms, and treatments for alcoholism. Alcohol acts as a depressant on the central nervous system and can cause intoxication, coma and death in high doses.
This document discusses alcohol intoxication and withdrawal. It begins by outlining the global impact of alcohol abuse, noting that it results in over 2.5 million deaths per year. It then covers topics such as the absorption, distribution, and metabolism of alcohol; signs of acute intoxication; associated medical issues like alcoholic ketoacidosis and hypoglycemia; withdrawal syndrome; and treatment approaches for acute intoxication and withdrawal. For methanol poisoning, it discusses toxicokinetics, clinical features, diagnostic testing, and aggressive medical management including administering ethanol or fomepizole to block methanol metabolism.
The document discusses hair dye poisoning, which is emerging as a common means of suicide, especially among females in India. Hair dyes contain toxic ingredients like paraphenylenediamine (PPD) and resorcinol. Poisoning symptoms include angioedema, rhabdomyolysis, myocarditis, and renal failure. Treatment focuses on airway protection, fluid resuscitation, dialysis, and managing complications to prevent death. Raising awareness about hair dye poisoning can help reduce mortality through early intervention.
This document discusses fluid management in pediatric patients. It covers the following key points:
- Body fluids are composed of intracellular and extracellular fluid compartments. Total body water varies with age.
- Intravenous fluids aim to maintain hydration and electrolyte balance. Common IV fluids include normal saline, Ringer's lactate, and dextrose solutions.
- Maintenance fluid rates are calculated based on weight and age to replace insensible water losses and electrolytes. Fluid deficits from conditions like diarrhea are replaced in addition to maintenance needs.
This document summarizes the pharmacokinetics, toxicity, and clinical effects of various alcohols including ethanol, isopropanol, and methanol. Ethanol is rapidly absorbed through the stomach and intestine and metabolized in the liver. Common signs of intoxication include sedation, hypoglycemia, and respiratory depression. Methanol is metabolized to toxic compounds that can cause metabolic acidosis, visual impairment, and death. Treatment involves blocking metabolism using ethanol or fomepizole to prevent formation of toxic metabolites.
A 14-year-old boy presented to the emergency department with symptoms of an autonomic storm after being bitten by a scorpion. He was diagnosed with scorpion sting in autonomic storm. He was given prazosin, hydrocortisone, and other supportive treatments. His condition stabilized and he was discharged after 6 days. Scorpion stings can cause local effects and a systemic autonomic storm response due to neurotoxins that affect sodium channels and induce catecholamine release. Prazosin is an effective treatment as it blocks alpha receptors and counters the effects of venom.
This document discusses drowning, providing definitions and discussing epidemiology, pathophysiology, management, and related topics. It notes that drowning is the process of experiencing respiratory impairment from submersion or immersion in liquid. The highest drowning death rates are seen in children aged 1-4 and 15-19, with common locations being bathtubs, pools, and natural water reservoirs. Progressive hypoxia and hypothermia can occur, affecting multiple organ systems. Management focuses on rapid oxygenation, ventilation, and circulation in the pre-hospital setting, followed by careful monitoring of cardiopulmonary and neurological status in the hospital.
This document discusses the causes, examination, and approach to an unconscious patient. It lists various potential causes of unconsciousness including trauma, hypoxia, infection, hemorrhage, metabolic disturbances, organ failure, drugs, and more. It describes examining the patient's vital signs, neurological status including level of consciousness assessed by GCS, and potential pupil abnormalities. Key steps in management involve supporting life functions, diagnosing the cause through history, focused exam, and investigations, and then treating reversible causes.
The document discusses ethanol (ethyl alcohol) and its effects as an inebriant substance. It defines alcohol and its origins, describes its production and metabolism in the body, acute and chronic effects on health, signs of alcohol poisoning and withdrawal symptoms, and treatments for alcoholism. Alcohol acts as a depressant on the central nervous system and can cause intoxication, coma and death in high doses.
This document discusses alcohol intoxication and withdrawal. It begins by outlining the global impact of alcohol abuse, noting that it results in over 2.5 million deaths per year. It then covers topics such as the absorption, distribution, and metabolism of alcohol; signs of acute intoxication; associated medical issues like alcoholic ketoacidosis and hypoglycemia; withdrawal syndrome; and treatment approaches for acute intoxication and withdrawal. For methanol poisoning, it discusses toxicokinetics, clinical features, diagnostic testing, and aggressive medical management including administering ethanol or fomepizole to block methanol metabolism.
The document discusses hair dye poisoning, which is emerging as a common means of suicide, especially among females in India. Hair dyes contain toxic ingredients like paraphenylenediamine (PPD) and resorcinol. Poisoning symptoms include angioedema, rhabdomyolysis, myocarditis, and renal failure. Treatment focuses on airway protection, fluid resuscitation, dialysis, and managing complications to prevent death. Raising awareness about hair dye poisoning can help reduce mortality through early intervention.
This document discusses fluid management in pediatric patients. It covers the following key points:
- Body fluids are composed of intracellular and extracellular fluid compartments. Total body water varies with age.
- Intravenous fluids aim to maintain hydration and electrolyte balance. Common IV fluids include normal saline, Ringer's lactate, and dextrose solutions.
- Maintenance fluid rates are calculated based on weight and age to replace insensible water losses and electrolytes. Fluid deficits from conditions like diarrhea are replaced in addition to maintenance needs.
This document summarizes the pharmacokinetics, toxicity, and clinical effects of various alcohols including ethanol, isopropanol, and methanol. Ethanol is rapidly absorbed through the stomach and intestine and metabolized in the liver. Common signs of intoxication include sedation, hypoglycemia, and respiratory depression. Methanol is metabolized to toxic compounds that can cause metabolic acidosis, visual impairment, and death. Treatment involves blocking metabolism using ethanol or fomepizole to prevent formation of toxic metabolites.
A 14-year-old boy presented to the emergency department with symptoms of an autonomic storm after being bitten by a scorpion. He was diagnosed with scorpion sting in autonomic storm. He was given prazosin, hydrocortisone, and other supportive treatments. His condition stabilized and he was discharged after 6 days. Scorpion stings can cause local effects and a systemic autonomic storm response due to neurotoxins that affect sodium channels and induce catecholamine release. Prazosin is an effective treatment as it blocks alpha receptors and counters the effects of venom.
This document discusses drowning, providing definitions and discussing epidemiology, pathophysiology, management, and related topics. It notes that drowning is the process of experiencing respiratory impairment from submersion or immersion in liquid. The highest drowning death rates are seen in children aged 1-4 and 15-19, with common locations being bathtubs, pools, and natural water reservoirs. Progressive hypoxia and hypothermia can occur, affecting multiple organ systems. Management focuses on rapid oxygenation, ventilation, and circulation in the pre-hospital setting, followed by careful monitoring of cardiopulmonary and neurological status in the hospital.
Alcohol intoxication can present with behavioral, cardiac, gastrointestinal, pulmonary, neurological, and metabolic manifestations. Diagnosis involves taking a history, physical exam looking for signs like capillary prominence and spider naevi, and measuring blood alcohol concentration and serum osmolality. Differential diagnosis includes other causes of altered mental status. Management focuses on stabilizing the patient's condition in the emergency department. It can be important to distinguish acute intoxication from chronic alcohol abuse or dependence, which may require different treatment approaches.
This document summarizes the clinical presentation, signs, radiographic findings, and management of hydrocarbon poisoning from inhalation or ingestion. The initial symptoms are respiratory in nature and include choking, coughing, and vomiting. Chest X-rays typically show perihilar or lobar densities within a few hours that can persist for days. Treatment is supportive, with attention to respiratory symptoms, and antibiotics may be used if bacterial pneumonia develops. Prevention efforts include storing kerosene out of children's reach and clearly labeling containers.
This document summarizes the pathophysiology, clinical presentation, management, and prognosis of kerosene poisoning in children. Kerosene easily penetrates the lungs due to its low viscosity and surface tension, causing chemical pneumonitis that can lead to respiratory failure. Symptoms include cough, tachypnea, hypoxemia, and neurological effects. Management involves supportive care, with intubation and ventilation for severe cases. Gastric decontamination methods are not recommended due to risk of aspiration. Outcomes are generally good with supportive care alone, though extracorporeal membrane oxygenation or high frequency ventilation may be life-saving in severe cases unresponsive to conventional ventilation.
Scorpion envenomation is a major public health problem worldwide, especially in developing countries like Iraq. Over 1.2 million scorpion stings occur annually, resulting in around 3250 deaths. The two most common scorpion families in Iraq are Scorpionidae and Buthidae. Androctonus crassicauda and Hottentotta saulcyi account for a large percentage of scorpion stings in Iraq. Scorpion venom contains various toxins that can cause a range of symptoms from local effects to potentially lethal systemic effects affecting the cardiovascular, respiratory, and neurological systems. Clinical manifestations depend on several factors and range from mild to potentially fatal symptoms.
This document discusses dengue in children, including its epidemiology, etiology, pathogenesis, clinical manifestations, management, and differential diagnosis. Some key points:
- Dengue is a mosquito-borne viral disease spread by Aedes mosquitoes and endemic in most parts of the world except Europe. It has four serotypes.
- The virus causes capillary damage and fluid leakage, which can lead to hypovolemia, shock, organ dysfunction, and hemorrhage in severe cases. Secondary infection with a new serotype increases risk.
- Clinical phases include fever, critical, and recovery. Warning signs like abdominal pain, vomiting indicate risk of severe disease. Management involves fluid management, monitoring for shock
INTRODUCTION:
Kerosene is a low viscosity flammable liquid.
Three types of kerosene mainly available in the market:
Commercial Kerosene ( Colourless)
PDS (Public Demand Supply – Blue dyed)
Aircraft fuel
Kerosene is known to cause harm to various body organs and systems.
Poisoning is usually due to ingestion either accidentally (in children) or with suicidal intent (in adults) and sometimes due to inhalation of fumes.
Kerosene poisoning is a very uncommon mode of poisoning.
EXPOSURE AND TOXICOKINETICS :
MECHANISM OF TOXICITY :
Toxicity is:
Due to exposure of un-combusted row kerosene.
Due to fuel performance additives.
Due to its exhaust emission
Kerosene is a mixture of n-alkane, branched alkanes, alkyl mono-aromatics, diaromatics, naphthalene, and polynuclear aromatics.
CLINICAL SYMPTOMS:
Respiratory effects: Acute respiratory infect, Lung cancer, Pulmonary tuberculosis, and Asthma.
Cardiac effects: Cardiac arrhythmia and Ventricular fibrillation.
Dermal effects: Dermal irritation, sensitization, skin lesions, and dermatitis.
Ocular effects: Mild irritation to eye induced to hyperaemic conjunctivitis and lacrimation.
TREATMENT:
In the case of acute exposures, the first step is to remove the patient from exposure.
In the case of ingestion of kerosene, Gastric lavage should not be undertaken.
Broad-Spectrum antibiotics like amoxicillin should be given through intravenously.
In the case of pulmonary pneumonitis, cefuroxime should be given through intravenously and oral.
Ceftriaxone is also included in the treatment system in combination with cefuroxime.
In the case of ocular exposure, immediately moisten the affected eye carefully with water and 0.9% saline.
HISTOPATHOLOGICAL AND POSTMORTEM EXAMINATION:
Histopathological examination of colonic biopsy revealed chronic discontinuous granulomatous inflammation of the colon.
On PM examination acute gastroenteritis and kerosene odor may be observed on the opening chest and abdominal cavity.
In the stomach, petechial hemorrhages with congested mucosa are found.
Degenerative changes in liver and kidneys and hypoplasia of bone marrow are the significant symptoms.
In case of suspected death from kerosene viscera preserved in saturated saline for chemical analysis.
ANALYSIS:
Kerosene in biological material is isolated by steam distillation.
The distillate should be collected in the ice-cold condition in a 20ml saturated solution of NaCl.
The top layer (1 cm.) of the distillate is taken out after some time and extracted four times with a 10ml portion of diethyl ether.
The combined ethereal extract is dried by passing through a hydrous sodium sulfate, evaporated at room temperature and subjected to analyze in a UV spectrophotometer.
On scanning in the e UV spectrophotometer, maxima are observed at 223 – 228 µm.
A small amount of extract is also used to examine in headspace GC-MS and compare with standard peaks. (for kerosene ≈270nm).
The document defines various types of strokes and transient ischemic attacks. It discusses the epidemiology, risk factors, clinical features, investigations, and management of strokes. The main types are ischemic and hemorrhagic strokes. Investigations include brain imaging like CT scan and MRI to identify the type of stroke and underlying causes. Treatment focuses on minimizing brain damage, preventing complications, rehabilitation, and reducing the risk of recurrence.
Emergency treatment of stroke involves several steps:
1. Rapid diagnosis through imaging such as CT or MRI to determine if the stroke is ischemic or hemorrhagic.
2. For ischemic strokes within 3 hours, treatment with rTPA (recombinant tissue plasminogen activator) can dissolve clots and reduce long-term disability if eligibility criteria are met.
3. Intensive monitoring is required after rTPA to control blood pressure and watch for bleeding complications.
4. Surgery may be considered for large hemorrhagic strokes or subarachnoid hemorrhage from aneurysms to relieve pressure on the brain.
This document discusses status epilepticus, which is defined as prolonged or repeated seizures without recovery between seizures. It classifies status epilepticus, explores its pathophysiology and etiology, and outlines its presentation, differential diagnosis, workup, and management. Status epilepticus results from either failed seizure termination mechanisms or initiation of mechanisms leading to prolonged seizures. It can cause neuronal death or injury if not promptly treated. Management involves initial treatment with benzodiazepines followed by anti-seizure medications like fosphenytoin or anesthetic doses if seizures persist over 40 minutes.
This document provides information on chronic cough in children, including definitions, epidemiology, pathophysiology, causes, diagnostic approach, and management. It defines chronic cough as lasting 4 or more weeks based on expert guidelines. Specific cough has an identifiable cause while nonspecific cough does not after evaluation. Common causes include asthma, aspiration, and suppurative lung diseases. The diagnostic approach involves detailed history, physical exam focusing on cough characteristics, chest imaging, and additional tests as needed based on findings. Management targets treating the identified cause for specific cough or watchful waiting for most nonspecific cough cases.
This document provides information on corrosive poisoning, including types, mechanisms of injury, clinical features, investigations, management, and treatment. It discusses three main types of corrosives - acids, alkalis, and oxidants. Alkalis are noted as the most dangerous due to their ability to rapidly cause liquifactive necrosis and injury. Clinical features involve the gastrointestinal tract, respiratory system, eyes and skin. Investigations include endoscopy, imaging, and labs. Management focuses on airway protection, dilution, antibiotics, and monitoring. Long term complications like stricture formation may require repeated dilations.
This document discusses different types of tremors, including essential tremor, parkinsonian tremor, enhanced physiologic tremor, drug-induced tremor, cerebellar tremor, psychogenic tremor, dystonic tremor, and Wilson's disease tremor. It provides details on symptoms, causes, diagnostic criteria and approach for each type. The most common tremors are essential tremor, parkinsonian tremor, and enhanced physiologic tremor. A thorough history, physical exam, and categorization of tremor characteristics are important for diagnosis.
Dr. Syed Muhammad Ali Shah provides an overview of ischemic stroke. Key points include:
- Stroke is defined as rapid onset of neurological deficit lasting over 24 hours caused by a vascular issue.
- Risk factors include atrial fibrillation, hypertension, smoking, obesity, and high cholesterol.
- Diagnosis involves investigations like CT scans and MRI. Treatment depends on the cause but may include thrombolysis within 4.5 hours, aspirin, rehabilitation, and preventing future strokes through controlling risk factors.
- Future advances include endovascular therapies to remove clots and research on neuroprotection strategies. Prevention through lifestyle changes and medications can reduce stroke risk.
Hypertensive Encephalopathy and Emergenciessazzad92
This document discusses hypertensive encephalopathy and hypertensive emergencies. It defines hypertensive encephalopathy as a condition caused by very high blood pressure that results in neurological symptoms. It describes the pathogenesis, symptoms, investigations, diagnosis, and treatment, which involves slowly lowering blood pressure over 24-48 hours. Hypertensive emergencies involve acute severe blood pressure elevations that cause end organ damage and require admission and rapid blood pressure control within hours to prevent further damage. The document outlines the clinical features, diagnosis, and treatments for hypertensive emergencies depending on the affected organ.
1. Convulsive status epilepticus has a bimodal distribution, peaking in children and the elderly, and has multiple potential causes including infections, strokes, alcohol withdrawal and brain injuries.
2. Mortality rates range from 10.5-28% and neurological sequelae occur in 11-16% of patients. Refractory status epilepticus is defined as continuing despite benzodiazepines and other anticonvulsants.
3. Treatment involves terminating seizures acutely with benzodiazepines like lorazepam and diazepam. For refractory cases, second line drugs like phenytoin, fosphenytoin, valproate, levetirac
The hypertensive encephalopathy is a syndrome consisting of a sudden elevation of arterial pressure usually preceded by severe headache and followed by convulsions, coma or a variety of transitory cerebral phenomena.
1. Alcohol poisoning can occur from both acute and chronic alcohol consumption and has effects throughout the body, especially the central nervous system, gastrointestinal tract, and liver.
2. Treatment for acute alcohol poisoning involves first aid measures like keeping the person awake and monitoring their symptoms, followed by further treatment in the hospital like gastric lavage and IV fluids.
3. Chronic alcohol use can lead to conditions like liver cirrhosis and Korsakoff's psychosis. Treatment focuses on medications to prevent further alcohol use and psychotherapy. Death from alcohol poisoning may result from related causes like traffic accidents, suicide, or organ failure.
R.M., a 35-year-old male, presented with sudden onset of dizziness, vomiting, left-sided weakness, slurred speech, and loss of coordination on the left side. His neurological exam showed signs consistent with a right pontine cerebellar stroke, including lateral rectus palsy and facial droop on the left side. Imaging revealed an old infarct in the right cerebellar hemisphere. The patient's risk factors included a family history of cardiovascular disease and a 25 pack-year smoking history. He was diagnosed with a stroke in the young, likely due to thrombotic occlusion from underlying vascular risk factors.
Super-vasmol hair dye poisoning is a major cause of suicidal poisoning in India, as its main toxic ingredient, paraphenylene diamine (PPD), is cheap and readily available. PPD poisoning can cause multi-organ dysfunction and failure through two phases - an initial acute presentation with angioedema and airway obstruction within 4-6 hours, followed by a subacute phase involving rhabdomyolysis, acute renal failure, hepatitis, and metabolic acidosis. Aggressive management is focused on airway protection, steroids to reduce angioedema, fluid resuscitation to prevent renal failure, and dialysis as needed.
This document discusses various tools used to assess levels of consciousness in patients, including the Glasgow Coma Scale (GCS). The GCS is useful for grading altered consciousness and severity of central nervous system insults in adults and older children. It has disadvantages like being impossible to score if eyes cannot be opened or if a patient is intubated. The document also introduces the FOUR score and Modified Morray Coma Score, which aim to address some of the GCS limitations.
1) Alcohol is rapidly absorbed into the bloodstream and distributed throughout total body water, reaching peak blood levels around 30 minutes after ingestion when the stomach is empty.
2) Metabolism of alcohol occurs mainly in the liver by alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (ALDH), accounting for 90-98% of ingested alcohol.
3) Acute alcohol intoxication can impair judgment and motor control at blood alcohol concentrations (BAC) of 20-30 mg/dL and cause gross intoxication over 50 mg/dL, presenting risks such as blackouts, vomiting, and aggression that require medical monitoring.
This document discusses toxic alcohols including ethanol, methanol, ethylene glycol, and isopropanol. It provides details on the sources, metabolism, clinical effects, diagnosis, and treatment of toxic alcohol poisoning for each substance. Key points include the different metabolic pathways, symptoms based on serum concentration levels, use of antidotes like ethanol or fomepizole to prevent metabolism, and indications for hemodialysis in severe poisonings.
Alcohol intoxication can present with behavioral, cardiac, gastrointestinal, pulmonary, neurological, and metabolic manifestations. Diagnosis involves taking a history, physical exam looking for signs like capillary prominence and spider naevi, and measuring blood alcohol concentration and serum osmolality. Differential diagnosis includes other causes of altered mental status. Management focuses on stabilizing the patient's condition in the emergency department. It can be important to distinguish acute intoxication from chronic alcohol abuse or dependence, which may require different treatment approaches.
This document summarizes the clinical presentation, signs, radiographic findings, and management of hydrocarbon poisoning from inhalation or ingestion. The initial symptoms are respiratory in nature and include choking, coughing, and vomiting. Chest X-rays typically show perihilar or lobar densities within a few hours that can persist for days. Treatment is supportive, with attention to respiratory symptoms, and antibiotics may be used if bacterial pneumonia develops. Prevention efforts include storing kerosene out of children's reach and clearly labeling containers.
This document summarizes the pathophysiology, clinical presentation, management, and prognosis of kerosene poisoning in children. Kerosene easily penetrates the lungs due to its low viscosity and surface tension, causing chemical pneumonitis that can lead to respiratory failure. Symptoms include cough, tachypnea, hypoxemia, and neurological effects. Management involves supportive care, with intubation and ventilation for severe cases. Gastric decontamination methods are not recommended due to risk of aspiration. Outcomes are generally good with supportive care alone, though extracorporeal membrane oxygenation or high frequency ventilation may be life-saving in severe cases unresponsive to conventional ventilation.
Scorpion envenomation is a major public health problem worldwide, especially in developing countries like Iraq. Over 1.2 million scorpion stings occur annually, resulting in around 3250 deaths. The two most common scorpion families in Iraq are Scorpionidae and Buthidae. Androctonus crassicauda and Hottentotta saulcyi account for a large percentage of scorpion stings in Iraq. Scorpion venom contains various toxins that can cause a range of symptoms from local effects to potentially lethal systemic effects affecting the cardiovascular, respiratory, and neurological systems. Clinical manifestations depend on several factors and range from mild to potentially fatal symptoms.
This document discusses dengue in children, including its epidemiology, etiology, pathogenesis, clinical manifestations, management, and differential diagnosis. Some key points:
- Dengue is a mosquito-borne viral disease spread by Aedes mosquitoes and endemic in most parts of the world except Europe. It has four serotypes.
- The virus causes capillary damage and fluid leakage, which can lead to hypovolemia, shock, organ dysfunction, and hemorrhage in severe cases. Secondary infection with a new serotype increases risk.
- Clinical phases include fever, critical, and recovery. Warning signs like abdominal pain, vomiting indicate risk of severe disease. Management involves fluid management, monitoring for shock
INTRODUCTION:
Kerosene is a low viscosity flammable liquid.
Three types of kerosene mainly available in the market:
Commercial Kerosene ( Colourless)
PDS (Public Demand Supply – Blue dyed)
Aircraft fuel
Kerosene is known to cause harm to various body organs and systems.
Poisoning is usually due to ingestion either accidentally (in children) or with suicidal intent (in adults) and sometimes due to inhalation of fumes.
Kerosene poisoning is a very uncommon mode of poisoning.
EXPOSURE AND TOXICOKINETICS :
MECHANISM OF TOXICITY :
Toxicity is:
Due to exposure of un-combusted row kerosene.
Due to fuel performance additives.
Due to its exhaust emission
Kerosene is a mixture of n-alkane, branched alkanes, alkyl mono-aromatics, diaromatics, naphthalene, and polynuclear aromatics.
CLINICAL SYMPTOMS:
Respiratory effects: Acute respiratory infect, Lung cancer, Pulmonary tuberculosis, and Asthma.
Cardiac effects: Cardiac arrhythmia and Ventricular fibrillation.
Dermal effects: Dermal irritation, sensitization, skin lesions, and dermatitis.
Ocular effects: Mild irritation to eye induced to hyperaemic conjunctivitis and lacrimation.
TREATMENT:
In the case of acute exposures, the first step is to remove the patient from exposure.
In the case of ingestion of kerosene, Gastric lavage should not be undertaken.
Broad-Spectrum antibiotics like amoxicillin should be given through intravenously.
In the case of pulmonary pneumonitis, cefuroxime should be given through intravenously and oral.
Ceftriaxone is also included in the treatment system in combination with cefuroxime.
In the case of ocular exposure, immediately moisten the affected eye carefully with water and 0.9% saline.
HISTOPATHOLOGICAL AND POSTMORTEM EXAMINATION:
Histopathological examination of colonic biopsy revealed chronic discontinuous granulomatous inflammation of the colon.
On PM examination acute gastroenteritis and kerosene odor may be observed on the opening chest and abdominal cavity.
In the stomach, petechial hemorrhages with congested mucosa are found.
Degenerative changes in liver and kidneys and hypoplasia of bone marrow are the significant symptoms.
In case of suspected death from kerosene viscera preserved in saturated saline for chemical analysis.
ANALYSIS:
Kerosene in biological material is isolated by steam distillation.
The distillate should be collected in the ice-cold condition in a 20ml saturated solution of NaCl.
The top layer (1 cm.) of the distillate is taken out after some time and extracted four times with a 10ml portion of diethyl ether.
The combined ethereal extract is dried by passing through a hydrous sodium sulfate, evaporated at room temperature and subjected to analyze in a UV spectrophotometer.
On scanning in the e UV spectrophotometer, maxima are observed at 223 – 228 µm.
A small amount of extract is also used to examine in headspace GC-MS and compare with standard peaks. (for kerosene ≈270nm).
The document defines various types of strokes and transient ischemic attacks. It discusses the epidemiology, risk factors, clinical features, investigations, and management of strokes. The main types are ischemic and hemorrhagic strokes. Investigations include brain imaging like CT scan and MRI to identify the type of stroke and underlying causes. Treatment focuses on minimizing brain damage, preventing complications, rehabilitation, and reducing the risk of recurrence.
Emergency treatment of stroke involves several steps:
1. Rapid diagnosis through imaging such as CT or MRI to determine if the stroke is ischemic or hemorrhagic.
2. For ischemic strokes within 3 hours, treatment with rTPA (recombinant tissue plasminogen activator) can dissolve clots and reduce long-term disability if eligibility criteria are met.
3. Intensive monitoring is required after rTPA to control blood pressure and watch for bleeding complications.
4. Surgery may be considered for large hemorrhagic strokes or subarachnoid hemorrhage from aneurysms to relieve pressure on the brain.
This document discusses status epilepticus, which is defined as prolonged or repeated seizures without recovery between seizures. It classifies status epilepticus, explores its pathophysiology and etiology, and outlines its presentation, differential diagnosis, workup, and management. Status epilepticus results from either failed seizure termination mechanisms or initiation of mechanisms leading to prolonged seizures. It can cause neuronal death or injury if not promptly treated. Management involves initial treatment with benzodiazepines followed by anti-seizure medications like fosphenytoin or anesthetic doses if seizures persist over 40 minutes.
This document provides information on chronic cough in children, including definitions, epidemiology, pathophysiology, causes, diagnostic approach, and management. It defines chronic cough as lasting 4 or more weeks based on expert guidelines. Specific cough has an identifiable cause while nonspecific cough does not after evaluation. Common causes include asthma, aspiration, and suppurative lung diseases. The diagnostic approach involves detailed history, physical exam focusing on cough characteristics, chest imaging, and additional tests as needed based on findings. Management targets treating the identified cause for specific cough or watchful waiting for most nonspecific cough cases.
This document provides information on corrosive poisoning, including types, mechanisms of injury, clinical features, investigations, management, and treatment. It discusses three main types of corrosives - acids, alkalis, and oxidants. Alkalis are noted as the most dangerous due to their ability to rapidly cause liquifactive necrosis and injury. Clinical features involve the gastrointestinal tract, respiratory system, eyes and skin. Investigations include endoscopy, imaging, and labs. Management focuses on airway protection, dilution, antibiotics, and monitoring. Long term complications like stricture formation may require repeated dilations.
This document discusses different types of tremors, including essential tremor, parkinsonian tremor, enhanced physiologic tremor, drug-induced tremor, cerebellar tremor, psychogenic tremor, dystonic tremor, and Wilson's disease tremor. It provides details on symptoms, causes, diagnostic criteria and approach for each type. The most common tremors are essential tremor, parkinsonian tremor, and enhanced physiologic tremor. A thorough history, physical exam, and categorization of tremor characteristics are important for diagnosis.
Dr. Syed Muhammad Ali Shah provides an overview of ischemic stroke. Key points include:
- Stroke is defined as rapid onset of neurological deficit lasting over 24 hours caused by a vascular issue.
- Risk factors include atrial fibrillation, hypertension, smoking, obesity, and high cholesterol.
- Diagnosis involves investigations like CT scans and MRI. Treatment depends on the cause but may include thrombolysis within 4.5 hours, aspirin, rehabilitation, and preventing future strokes through controlling risk factors.
- Future advances include endovascular therapies to remove clots and research on neuroprotection strategies. Prevention through lifestyle changes and medications can reduce stroke risk.
Hypertensive Encephalopathy and Emergenciessazzad92
This document discusses hypertensive encephalopathy and hypertensive emergencies. It defines hypertensive encephalopathy as a condition caused by very high blood pressure that results in neurological symptoms. It describes the pathogenesis, symptoms, investigations, diagnosis, and treatment, which involves slowly lowering blood pressure over 24-48 hours. Hypertensive emergencies involve acute severe blood pressure elevations that cause end organ damage and require admission and rapid blood pressure control within hours to prevent further damage. The document outlines the clinical features, diagnosis, and treatments for hypertensive emergencies depending on the affected organ.
1. Convulsive status epilepticus has a bimodal distribution, peaking in children and the elderly, and has multiple potential causes including infections, strokes, alcohol withdrawal and brain injuries.
2. Mortality rates range from 10.5-28% and neurological sequelae occur in 11-16% of patients. Refractory status epilepticus is defined as continuing despite benzodiazepines and other anticonvulsants.
3. Treatment involves terminating seizures acutely with benzodiazepines like lorazepam and diazepam. For refractory cases, second line drugs like phenytoin, fosphenytoin, valproate, levetirac
The hypertensive encephalopathy is a syndrome consisting of a sudden elevation of arterial pressure usually preceded by severe headache and followed by convulsions, coma or a variety of transitory cerebral phenomena.
1. Alcohol poisoning can occur from both acute and chronic alcohol consumption and has effects throughout the body, especially the central nervous system, gastrointestinal tract, and liver.
2. Treatment for acute alcohol poisoning involves first aid measures like keeping the person awake and monitoring their symptoms, followed by further treatment in the hospital like gastric lavage and IV fluids.
3. Chronic alcohol use can lead to conditions like liver cirrhosis and Korsakoff's psychosis. Treatment focuses on medications to prevent further alcohol use and psychotherapy. Death from alcohol poisoning may result from related causes like traffic accidents, suicide, or organ failure.
R.M., a 35-year-old male, presented with sudden onset of dizziness, vomiting, left-sided weakness, slurred speech, and loss of coordination on the left side. His neurological exam showed signs consistent with a right pontine cerebellar stroke, including lateral rectus palsy and facial droop on the left side. Imaging revealed an old infarct in the right cerebellar hemisphere. The patient's risk factors included a family history of cardiovascular disease and a 25 pack-year smoking history. He was diagnosed with a stroke in the young, likely due to thrombotic occlusion from underlying vascular risk factors.
Super-vasmol hair dye poisoning is a major cause of suicidal poisoning in India, as its main toxic ingredient, paraphenylene diamine (PPD), is cheap and readily available. PPD poisoning can cause multi-organ dysfunction and failure through two phases - an initial acute presentation with angioedema and airway obstruction within 4-6 hours, followed by a subacute phase involving rhabdomyolysis, acute renal failure, hepatitis, and metabolic acidosis. Aggressive management is focused on airway protection, steroids to reduce angioedema, fluid resuscitation to prevent renal failure, and dialysis as needed.
This document discusses various tools used to assess levels of consciousness in patients, including the Glasgow Coma Scale (GCS). The GCS is useful for grading altered consciousness and severity of central nervous system insults in adults and older children. It has disadvantages like being impossible to score if eyes cannot be opened or if a patient is intubated. The document also introduces the FOUR score and Modified Morray Coma Score, which aim to address some of the GCS limitations.
1) Alcohol is rapidly absorbed into the bloodstream and distributed throughout total body water, reaching peak blood levels around 30 minutes after ingestion when the stomach is empty.
2) Metabolism of alcohol occurs mainly in the liver by alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (ALDH), accounting for 90-98% of ingested alcohol.
3) Acute alcohol intoxication can impair judgment and motor control at blood alcohol concentrations (BAC) of 20-30 mg/dL and cause gross intoxication over 50 mg/dL, presenting risks such as blackouts, vomiting, and aggression that require medical monitoring.
This document discusses toxic alcohols including ethanol, methanol, ethylene glycol, and isopropanol. It provides details on the sources, metabolism, clinical effects, diagnosis, and treatment of toxic alcohol poisoning for each substance. Key points include the different metabolic pathways, symptoms based on serum concentration levels, use of antidotes like ethanol or fomepizole to prevent metabolism, and indications for hemodialysis in severe poisonings.
An addiction is a complex brain disease that causes physical and mental dependence on drugs. Prolonged drug use changes the brain's structure and communication, making it difficult to stop using drugs. While addiction can be treated through rehabilitation, relapses and health issues often remain. Many factors contribute to drug addiction, including environment, biology, development, and peer pressure. Different drugs have various short-term and long-term effects on physical and mental health. Seeking help from a drug helpline is recommended for those struggling with addiction.
The most common drug is marijuana. Marijuana use is increasing while opium and cocaine use are decreasing. The year 2000 saw the highest rates of drug use according to the document.
This document discusses the toxicity of ethanol. It is a colorless, volatile liquid that readily diffuses through membranes and is metabolized in the liver. Chronic ethanol consumption can lead to malnutrition, oxidative stress, production of toxic metabolites like acetaldehyde, and increased risk of cancer. Clinical effects include inebriation, respiratory depression, hypothermia, and dysrhythmias. Blood tests can assess electrolyte abnormalities. Treatment involves stabilization, fluid/electrolyte correction, and occasionally hemodialysis. Ethanol metabolism can also cause hypoglycemia or alcoholic ketoacidosis in malnourished chronic drinkers.
- Drug addiction and abuse refers to the chronic or habitual use of any chemical substance to alter states of body or mind for non-medical purposes. This includes both licit and illicit drugs.
- Addiction is compulsive drug use despite harm, while substance abuse refers to frequently using drugs like alcohol and inhalants that can be addictive.
- Dependence involves psychological need for a drug and physical tolerance and withdrawal symptoms. Addiction affects the reward pathway in the brain.
- Drug abuse has negative effects on individuals, families, and society through health issues, crime, and lost productivity.
The document discusses drugs, drug abuse, and addiction. It defines drugs as substances that alter normal bodily functions when absorbed into the body. It notes that drug abuse is an intense desire to obtain increasing amounts of a substance and that drug dependence results in physical harm and behavioral issues over the long term. The document also shares the story of a teenager named Alby who abused drugs from ages 13 to 18 but was able to get treatment and now feels better about himself. It discusses surveys and activities conducted by students on these topics, including visiting a rehabilitation center.
This document provides information about drugs and their effects. It defines drugs as substances that affect the body and brain, and notes that not all drugs are illegal. It then discusses different types of drugs like depressants, stimulants, and hallucinogens, providing examples of each and their effects. The document also addresses why people use drugs, signs of drug use, and what can be done to help someone with a drug problem.
This document provides information on alcohol, its effects on the body, alcohol dependence and withdrawal, and treatment approaches. It discusses how alcohol acts in the brain to produce both pleasurable and reinforcing effects. It outlines recommended daily and weekly drinking limits, signs and symptoms of alcohol intoxication at different blood alcohol levels. It also summarizes common presentations to the emergency department related to alcohol, approaches to assessing and managing alcohol withdrawal, risks of Wernicke's encephalopathy from thiamine deficiency, and options for ongoing treatment and support.
Alzheimer's disease is a degenerative brain disease that results in cognitive and behavioral impairment. It accounts for around 70% of dementia cases. The hallmarks of the disease are amyloid plaques and neurofibrillary tangles in the brain. Symptoms include memory loss, confusion, changes in personality and behavior, and problems with language and visual-spatial skills. Treatment focuses on acetylcholinesterase inhibitors and memantine to manage symptoms, as well as non-pharmacological approaches to improve quality of life. The disease is progressive and currently has no cure.
This document discusses acute kidney injury (AKI). It defines AKI and outlines its causes including prerenal, renal, and postrenal. Risk factors, investigations, and management of AKI are reviewed. Three case studies of patients presenting with AKI are presented and questions are provided to test clinical decision making. Key steps in the acute management and workup of severe AKI cases are emphasized.
This document contains 26 multiple choice questions about physiology from an exam. It includes questions about the visual pathway, lateral geniculate nucleus, endothelial cells, pacemaker cells of the heart, temperature regulation, blood flow regulation, oxygen levels during exercise, nerve injury, motor neuron lesions, medical terms, hormone functions, alcohol withdrawal symptoms, thiamine deficiency, and more. The questions are from a review of physiology textbook and include the answers and brief explanations.
The document discusses alcohol withdrawal and alcoholic hepatitis. It notes that over 300,000 people in the UK have alcohol-related problems. Symptoms of alcohol withdrawal can begin within 12 hours and include agitation, nausea, and sweating. Delirium tremens can occur within 48 hours and is characterized by disorientation, agitation, and hallucinations. Treatment for alcohol withdrawal and hepatitis includes vitamins, fluids, antibiotics if needed, and benzodiazepines. Corticosteroids have shown benefits for severe alcoholic hepatitis defined as a Maddrey score over 32, reducing mortality rates. A pilot study combining corticosteroids and infliximab showed improvements in outcomes.
The document provides information about acute renal failure (ARF), including:
- ARF is the rapid loss of kidney function over hours to days, resulting in failure to excrete waste and electrolyte imbalance.
- The main causes of ARF are pre-renal (decreased renal perfusion), intrinsic renal (damage to the kidneys), and post-renal (obstruction of urinary outflow).
- Evaluation involves laboratory tests like urinalysis and renal indices to help determine the underlying cause and guide treatment, which depends on the identified etiology. Dialysis may be needed for severe cases.
The document provides information about acute renal failure (ARF), including:
- ARF is the rapid loss of kidney function over hours to days, resulting in failure to excrete waste and electrolyte imbalance.
- The main causes of ARF are pre-renal (decreased renal perfusion), intrinsic renal (damage to the kidneys), and post-renal (obstruction of urinary outflow).
- Evaluation involves laboratory tests like urinalysis and blood work to determine the specific cause and guide treatment, which ranges from intravenous fluids to dialysis depending on severity.
The document discusses hepatic encephalopathy, a neurological syndrome caused by liver dysfunction. It covers the pathogenesis, which involves neurotoxins like ammonia crossing the blood brain barrier and disrupting neurotransmitter levels. Symptoms range from mild confusion to coma and can be precipitated by factors that increase ammonia production or permeability of the blood brain barrier. Treatment focuses on managing precipitating factors and restricting protein intake to control ammonia levels.
alcohol perturbs the balance between excitatory and inhibitory influences in the brain, resulting in Anxiolysis. An increased reaction time, diminished fine motor control, impulsivity, and impaired judgement be come evident when the concentionof alcohol in the blood is 20-30mg/dl.
More than 50% of persons are grossly intoxicated by a conc. Of 150mg/dl.
The defintion of intoxication varies by country.
Alcohol can be measured in saliva, urine,sweat,and blood, level in exheled air remains the primary method of assessing the level of intoxication.
Ethanol (CH 3 CH 2 OH) is a water-soluble alcohol that rapidly crosses cell membranes.
Absorption of ethanol occurs via the gastrointestinal system, primarily in the stomach (70 percent) and duodenum (25 percent), with a small amount absorbed by the remaining intestine .
When the stomach is empty, peak blood ethanol levels are reached between 30 and 90 minutes after ingestion.
Acute thiamine deficiency, also known as Wernicke's encephalopathy, is a neurological disorder most prevalent in males around age 50 with a history of alcoholism or malnutrition. It results from a lack of thiamine (Vitamin B1), which is important for brain cell function. Left untreated, it can lead to Wernicke-Korsakoff syndrome characterized by amnesia and confusion. Treatment involves emergency high dose parenteral thiamine supplementation.
11 Turman Management Of Acute Renal Failure In PicuDang Thanh Tuan
This document provides an overview of the definition, causes, risk factors, evaluation, and management of acute renal failure (ARF) in pediatric intensive care unit patients. It discusses the importance of differentiating between pre-renal, renal, and post-renal causes of ARF. Key factors that influence outcomes like oliguria, multi-organ failure, and late initiation of dialysis are outlined. Fluid management and treatment of complications such as hypertension, electrolyte abnormalities, and anemia are also reviewed. Emerging potential new treatments for ARF are described but many have not proven effective in clinical trials.
1. Alcohol use disorder is defined as having difficulties in at least 2 of 11 life areas due to alcohol use over a 12-month period. The lifetime risk is 10-15% for men and 5-8% for women.
2. Consuming more than 3 standard drinks per day increases risks for cancer, vascular disease, and decreases life expectancy by about 10 years. Heavy drinking can also lead to alcoholic ketoacidosis, neurotransmission changes, and organ damage.
3. Treatment involves recognizing alcohol use disorder in at least 20% of patients, identifying and treating acute alcohol-related conditions, helping patients address their alcohol problems, and referring for additional treatment as needed.
This document discusses hypokalemia, including its pathophysiology, causes, symptoms, diagnosis, and management. Some key points:
- Hypokalemia is defined as a serum potassium level below 3.5 mmol/L. It can be caused by decreased intake, gastrointestinal loss, renal loss, or shifts of potassium into cells.
- Symptoms vary but can include cardiac arrhythmias, muscle weakness, and neurological issues. Diagnosis involves checking electrolytes, ECG, and investigating underlying causes.
- Treatment involves addressing the underlying cause, stopping offending drugs, and oral or IV potassium supplementation. Severe cases require IV potassium. Specific conditions like Gitelman syndrome are managed long
Fluid And Electrolyte Emergencies In Critically Ill ChildrenDang Thanh Tuan
This document presents several case studies of pediatric patients with fluid and electrolyte disorders. It discusses the differential diagnoses, diagnostic evaluations and treatment approaches for conditions such as Syndrome of Inappropriate Antidiuretic Hormone (SIADH), diabetes insipidus, adrenal insufficiency, and hypokalemia. Through a series of questions and answers, it aims to teach learners how to recognize, diagnose and manage common fluid and electrolyte emergencies in critically ill children.
Neurologic manifestations of alcoholism By Adetunji T.A.Adetunji Adesegun
This document provides an overview of alcohol-related neurologic disorders. It discusses the definition and epidemiology of alcoholism and defines units of alcohol. It describes various neurologic effects of alcohol including withdrawal syndrome, Wernicke-Korsakoff syndrome, alcoholic neuropathy, and fetal alcohol syndrome. It provides details on the pathogenesis and treatment of Wernicke's encephalopathy and Korsakoff's psychosis. The document also discusses various imaging findings and emphasizes the importance of early thiamine treatment.
This document discusses nutrition for patients with renal disease, cancer, and cognitive dysfunction syndrome. For renal disease, it outlines the clinical signs and stages. It emphasizes managing protein, phosphorus, potassium, and sodium levels according to IRIS guidelines. For cancer, it notes the metabolic changes and goals of increasing remission, survival time, and quality of life. It recommends a diet high in fat and protein but low in carbs, with arginine and omega-3s. For cognitive dysfunction syndrome, it discusses the potential causes being mitochondrial damage and oxidative stress. It presents study results showing cognitive benefit of specific therapeutic diets.
Similar to Alcohol related presentations to the emergency department (20)
The document discusses trauma teams and their roles. It defines a trauma team as a multidisciplinary group that works together to assess and treat severely injured patients. A team approach has been shown to significantly reduce resuscitation times compared to individual doctors. The roles of trauma team members are outlined, as well as techniques for effective communication, briefing, handover, and speaking up if concerns arise. Statistics from Western Australia in 2015 show the most common causes of death for major trauma patients were head injuries and brain death. Overall mortality rates were lower than the national average.
This document provides an overview of haemostatic resuscitation for trauma patients. It discusses the goals of haemostatic resuscitation which include rapidly correcting hypothermia, hypocalcaemia, acidosis and other factors impairing haemostasis. It also aims to resuscitate patients with a balanced combination of blood products resembling whole blood to avoid dilutional coagulopathy. The document reviews the components of blood, various blood products used in resuscitation and their effects, and studies supporting haemostatic resuscitation approaches. It also discusses practical considerations for haemostatic resuscitation in the emergency department setting.
Mr. Arthur Ritis, a 52-year-old man with diabetes, hypertension, and a history of gout, presented with a hot, swollen, and painful right knee for 24 hours. Examination found a warm knee with a large effusion and mild tenderness. Blood tests showed elevated white blood cell count and C-reactive protein. Arthrocentesis of the knee found cloudy yellow synovial fluid containing urate crystals on microscopy. This confirms the diagnosis of an acute gout attack in the knee requiring treatment.
This document discusses the use of echocardiography during cardiac arrest and peri-arrest situations. It provides an overview of basic echo views that can be useful. Echo can help identify the cause of arrest such as tamponade, pulmonary embolism, or wall motion abnormalities. Findings on echo such as hypovolaemia or myocardial activity can help guide management decisions. The document reviews where echo fits within the ACLS algorithm and issues surrounding its use during cardiac arrest. It provides examples of echo findings that may indicate treatable versus non-treatable causes of arrest.
The document discusses the goals of implementing a new Goals of Patient Care (GOPC) form across hospitals in Western Australia to improve end-of-life care and decision making. It provides background on the form's trial implementation at various sites. The new form aims to have goals of care discussions with patients or their surrogates to determine appropriate treatment based on probable outcomes, not just resuscitation status. It outlines the form's structure with sections on baseline information, goal of care selection, discussion summary, and extended use. The document emphasizes improving communication around goals of care and ensuring treatment aligns with patients' values and preferences.
This document discusses physiology directed CPR and haemodynamically directed CPR. It notes that cardiac arrest is not a diagnosis and various underlying pathologies must be considered. During closed chest compressions, a proportion of cardiac output is generated through cardiac and thoracic pumping. Studies show that targeting specific blood pressure and coronary perfusion pressure goals during CPR improves survival outcomes compared to standard AHA guidelines. Monitoring diastolic blood pressure and central venous pressure can help guide interventions like fluid administration or vasopressor use to meet haemodynamic targets and optimize circulation during CPR.
Ultrasound confirmation of ETT placementSCGH ED CME
This document discusses using ultrasound to confirm endotracheal tube placement. It states that ultrasound is a simple, fast, and reliable adjunct technique that can be used when other confirmation methods like capnography are unreliable or not available. There are two ultrasound techniques described - direct (transtracheal) ultrasound looks inside the trachea or esophagus to see if the tube is correctly placed, while indirect (transthoracic) ultrasound looks for movement of the pleura indicating lung ventilation. Ultrasound is not meant to replace capnography and auscultation but can be a helpful additional method in emergency situations or for patients who are not responding as expected after intubation. The document provides details on how to
Palliative care in the emergency departmentSCGH ED CME
This document provides guidance on symptom management for palliative patients in the emergency department. It outlines approaches for managing common symptoms like pain, delirium, dyspnea, nausea and vomiting. It recommends opiate medications for pain management, depending on whether the patient is opiate naïve or tolerant. It also provides guidance on managing other symptoms like bladder and bowel issues, secretions and more uncommon complications. The document emphasizes the importance of palliative care consultation and ensuring patients are not left to die alone.
Wilderness crisis and decision making weekend April 2018SCGH ED CME
This document announces a wilderness crisis and decision making weekend to take place in Margaret River, Australia from April 20-22, 2018. The weekend aims to build teamwork skills through quotes about collaborating, working together, and making decisions as a group. Activities will involve solving problems as a team rather than individuals.
Patient confidentiality in emergency departmentSCGH ED CME
Patient confidentiality must be maintained in the ED. Personal information about patients cannot be disclosed without consent, except in emergencies or if required by law. Duty consultants should be aware of any VIP patients but provide the same standard of care. Confidentiality must be respected even for those not under the practitioner's direct care. Mandatory notifications to regulatory bodies are required only for specific conduct issues. Advice can be sought from designated hospital staff if questions arise about disclosing information.
This document summarizes several studies on the use of antibiotics for abscess management. A 2016 RCT of over 1000 patients found that high-dose Bactrim led to higher cure rates of abscesses over 2cm compared to placebo, especially for those with MRSA, fevers, or immunosuppression. A 2017 RCT of under 800 patients found Bactrim and clindamycin had similar cure rates of abscesses under 5cm as placebo. However, antibiotics were associated with higher adverse gastrointestinal events. Overall, meta-analyses show antibiotics reduce treatment failures and new skin infections compared to incision and drainage alone, but with a risk of serious drug side effects.
This document discusses hyperthermia and hypothermia. It defines hyperthermia as a core body temperature above 41.5°C and describes the pathophysiology and various causes, including exercise-associated collapse, heatstroke, and drug-related illnesses. It also discusses hypothermia, defined as a core temperature below 35°C, and covers causes, clinical features at different temperature stages, complications, investigations, and management approaches including warming techniques. The prognosis depends on factors like maximum temperature reached and duration of temperature elevation.
- This document contains information on various electrical injury cases presented to the emergency department, including details on mechanisms of injury, clinical presentations, investigations, and management strategies. Key points include treating electrical injury patients as trauma patients, avoiding premature withdrawal of resuscitation due to the unreliable signs of death, monitoring for cardiac dysrhythmias, rhabdomyolysis, and neurovascular compromise of injured extremities. High voltage or lightning injuries can cause severe internal injuries despite minor external burns and require prolonged cardiac monitoring and aggressive IV fluid resuscitation.
This document summarizes an audit of CTPA scans ordered without a D-Dimer test for patients over 50. Of 53 CTPA scans reviewed, 49 did not have a D-Dimer. For most scans, the decision not to order a D-Dimer was appropriately documented. However, for 8 scans (16%) there was no documented reason for not ordering a D-Dimer. The audit concluded that CTPA scans are generally being ordered appropriately to diagnose PE, but better documentation of the reasons for not ordering D-Dimers could help reduce unnecessary CTPA use.
Good clinical documentation is critical for continuity of patient care, patient safety, legal records, and supporting accurate medical coding. The documentation provides information on why the patient was admitted and what treatments they received. The coders assign diagnosis and procedure codes based solely on the documented information. Ambiguous or incomplete documentation can result in inaccurate coding that affects funding. Ensuring documentation clearly specifies diagnoses, management plans, and interventions helps ensure patients are assigned to the appropriate Diagnosis Related Group (DRG) and the hospital receives appropriate funding for the services provided.
This document provides an overview of common paediatric rashes. It begins with describing the anatomy of the skin and definitions of common rash morphologies such as macules, papules, vesicles and pustules. Common rashes that are described include scabies, acne, contact dermatitis, atopic dermatitis, impetigo, tinea and nonspecific viral rashes. Specific viral exanthems like measles, rubella and scarlet fever are also reviewed. Emergent rashes like erythema multiforme, Stevens-Johnson syndrome and toxic epidermal necrolysis are discussed in terms of their presentations, causes and treatments. References are provided at the end.
Choosing Wisely - Rational Antibiotic UsageSCGH ED CME
This document summarizes a case study of a 28-year-old Australian woman who developed a rash and respiratory symptoms after returning from travel to Thailand. Initial testing ruled out common infections like malaria, dengue fever, and influenza. Her rash and symptoms were consistent with measles. Further diagnostic testing confirmed infection with herpes simplex virus 1 via a positive PCR test. The case highlights the importance of considering uncommon infections in returning travelers who present with rashes and respiratory symptoms.
What's Hot in Emergency Medicine June 2018SCGH ED CME
This document summarizes several hot topics in emergency medicine:
1) A study found imaging and blood cultures are often inappropriate for evaluating uncomplicated cellulitis according to guidelines.
2) A new pulmonary embolism pathway was introduced in 2018.
3) The Surviving Sepsis Campaign updated their sepsis bundles to a single 1-hour bundle in 2018.
4) There is debate around the evidence and recommendations of the Surviving Sepsis Campaign.
5) The terms used to describe new oral anticoagulants, like NOAC, are still appropriate according to hematology experts.
- The document appears to be a slide presentation on ophthalmic examination techniques. It includes descriptions of examining the orbit, extraocular movements, pupils, anterior segment, cornea, anterior chamber, iris, lens, and discs using a slit lamp. It also mentions assessing vision, intraocular pressure, and performing direct ophthalmoscopy.
- The presentation notes that the value of experience is not just seeing much, but seeing wisely. It asks if the viewer sees what the presenter sees.
- A list of time-critical conditions that require urgent attention is provided, including acute angle closure glaucoma, penetrating eye injuries, endophthalmitis, and retinal artery occlusion.
Code Brown - Disaster Medicine in the EDSCGH ED CME
The document outlines the emergency department's response plan for a "Code Brown", which refers to mass casualty incidents that exceed the hospital's normal capacity. The 4 phases of response are notification, standby/preparation, reception of casualties, and stand down. Key steps include activating staff call backs, setting up triage and treatment areas, prioritizing patient care, and addressing issues like family inquiries, transportation bottlenecks, and media relations. The plan emphasizes timely triage, treatment and flow of patients. A post-incident debriefing within 7 days allows for evaluating the response and making improvements.
NAVIGATING THE HORIZONS OF TIME LAPSE EMBRYO MONITORING.pdfRahul Sen
Time-lapse embryo monitoring is an advanced imaging technique used in IVF to continuously observe embryo development. It captures high-resolution images at regular intervals, allowing embryologists to select the most viable embryos for transfer based on detailed growth patterns. This technology enhances embryo selection, potentially increasing pregnancy success rates.
Are you looking for a long-lasting solution to your missing tooth?
Dental implants are the most common type of method for replacing the missing tooth. Unlike dentures or bridges, implants are surgically placed in the jawbone. In layman’s terms, a dental implant is similar to the natural root of the tooth. It offers a stable foundation for the artificial tooth giving it the look, feel, and function similar to the natural tooth.
- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Breast cancer: Post menopausal endocrine therapyDr. Sumit KUMAR
Breast cancer in postmenopausal women with hormone receptor-positive (HR+) status is a common and complex condition that necessitates a multifaceted approach to management. HR+ breast cancer means that the cancer cells grow in response to hormones such as estrogen and progesterone. This subtype is prevalent among postmenopausal women and typically exhibits a more indolent course compared to other forms of breast cancer, which allows for a variety of treatment options.
Diagnosis and Staging
The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
Staging involves determining the size of the tumor (T), the involvement of regional lymph nodes (N), and the presence of distant metastasis (M). The American Joint Committee on Cancer (AJCC) staging system is commonly used. Accurate staging is critical as it guides treatment decisions.
Treatment Options
Endocrine Therapy
Endocrine therapy is the cornerstone of treatment for HR+ breast cancer in postmenopausal women. The primary goal is to reduce the levels of estrogen or block its effects on cancer cells. Commonly used agents include:
Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
Chemotherapy is generally reserved for patients with high-risk features, such as large tumor size, high-grade histology, or extensive lymph node involvement. Regimens often include anthracyclines and taxanes.
PGx Analysis in VarSeq: A User’s PerspectiveGolden Helix
Since our release of the PGx capabilities in VarSeq, we’ve had a few months to gather some insights from various use cases. Some users approach PGx workflows by means of array genotyping or what seems to be a growing trend of adding the star allele calling to the existing NGS pipeline for whole genome data. Luckily, both approaches are supported with the VarSeq software platform. The genotyping method being used will also dictate what the scope of the tertiary analysis will be. For example, are your PGx reports a standalone pipeline or would your lab’s goal be to handle a dual-purpose workflow and report on PGx + Diagnostic findings.
The purpose of this webcast is to:
Discuss and demonstrate the approaches with array and NGS genotyping methods for star allele calling to prep for downstream analysis.
Following genotyping, explore alternative tertiary workflow concepts in VarSeq to handle PGx reporting.
Moreover, we will include insights users will need to consider when validating their PGx workflow for all possible star alleles and options you have for automating your PGx analysis for large number of samples. Please join us for a session dedicated to the application of star allele genotyping and subsequent PGx workflows in our VarSeq software.
STUDIES IN SUPPORT OF SPECIAL POPULATIONS: GERIATRICS E7shruti jagirdar
Unit 4: MRA 103T Regulatory affairs
This guideline is directed principally toward new Molecular Entities that are
likely to have significant use in the elderly, either because the disease intended
to be treated is characteristically a disease of aging ( e.g., Alzheimer's disease) or
because the population to be treated is known to include substantial numbers of
geriatric patients (e.g., hypertension).
How to Control Your Asthma Tips by gokuldas hospital.Gokuldas Hospital
Respiratory issues like asthma are the most sensitive issue that is affecting millions worldwide. It hampers the daily activities leaving the body tired and breathless.
The key to a good grip on asthma is proper knowledge and management strategies. Understanding the patient-specific symptoms and carving out an effective treatment likewise is the best way to keep asthma under control.
2. Overview
Some ED statistics
Pharmacology of ethanol
Acute Intoxication
Alcohol in trauma
Alcohol Withdrawal
Chronic alcoholism – special problems
Toxic Alcohols
Summary
Quiz
3. Some Statistics
3.3 million people world wide die from alcohol related illness p.a. (5.9%)
Over 5% of annual burden of disease as DALYs is due to alcohol worldwide
25% of deaths in 20-39 yr olds world wide are attributable to ETOH
ETOH is implicated in over 200 different health conditions
1 in 3 presentations to the ED in Australia are related to alcohol
In 2010 estimates 3.5% Australian pop are dependent or use harmfully
Australian men drink 20L per yr, women drink 9L per yr of pure alcohol
4. Pharmacology of Ethanol
CNS depressant
Potentiates action at GABA receptors and reduces NMDA activity (serotonin, NE)
Absorbed 20% gastric 80% small intestine; metabolised at liver & excreted
by kidney. 5% unchanged via lung. Water soluble. Zero order kinetics.
Metabolism
5. Acute Intoxication
Signs of acute intoxication
Nystagmus, ataxia, slurred speech, CNS depression, respiratory depression
Treatment – largely supportive. Aspiration risk – nurse on side.
Patient must not be a danger to self or others before ED discharge (e.g.
mobilise safely, responsible party will take home), passing urine
No evidence that IVT improves recovery time / hastens metabolism, or BAL,
but adds to cost of admission*
If patient is not alcohol dependent, thiamine is not required
6. Alcohol in Trauma
Higher suspicion for significant injuries e.g head trauma, c-spine
If history / mechanism is unclear and patient has altered GCS, cannot
assume it is due to alcohol. Lowered index to scan.
If patient not improving or deteriorating during observation – look for
alternate explanation
Intoxication is a consideration in NEXUS c-spine rules, but not Canadian
7. Alcohol Withdrawal
Minor withdrawal 6-24 hrs
Tremor, anxiety, N&V, insomnia
Major withdrawal 10-72 hrs
Alcoholic hallucinosis, whole body tremor, vomiting, diaphoresis, HTN
Seizures 6-48 hrs
Brief and generalised, normal EEG, up to 60% not treated for withdrawal, up to
40% will progress to DT
Delirium Tremens 3-10 days
Medical emergency. Global confusion is hallmark; autonomic hyperactivity, risk
of cardiovascular collapse, fluid / electrolyte disturbance. Large differential
diagnosis.
8. Chronic Alcoholism – Special Problems
Alcohol effects every bodily system
Cardiovascular – HTN, alcoholic cardiomyopathy (direct toxic effect)
Haematological – anaemia, thrombocytopaenia, macrocytosis, risk of infections, bleeding risk
Neurological – cerebral atrophy, ?alcohol dementia (loose criteria, in DSM-IV, often overlaps
with other forms of dementia, distinct from Korsakoff), head injuries / bleeds, cerebellar atrophy
Endocrine – hyperoestrogenism, hypoglycaemia, pancreatitis
Reproductive– spontaneous abortion, foetal alcohol sy, infertility (men & women), low birth wt
Misc – gout, Dupytreyn’s, myopathy
Psychosocial – financial, marital, violence, risk of sexual assault, employment.
Screening tools e.g. CAGE (cut down, annoyed, guilty, eye opener)
9. Thiamine Deficiency
Water soluble essential nutrient – Vitamin B1
Thiamine is phosphorylated in the gut to active coenzyme form, important
in ATP production, normal nerve conduction & maintenance of neural
membranes
Deficiency results from poor nutrition, decreased conversion to coenzyme,
reduced storage in fatty liver, ethanol may inhibit intestinal transport,
impaired absorption
Deficiency causes beriberi*
Dry beriberi – polyneuropathy (symmetrical, non-specific myelin degen, usually
lower limbs, affects sensory, motor and reflexive arcs. Progressive)
Wet beriberi – affects the heart, leading to high output cardiac failure
Wernicke-Korsakoff Syndrome
10. Wernicke-Korsakoff Syndrome
Spectrum of disease
Wernicke typically precedes, reversible if identified early
Ophthalmoplegia (esp. lateral recti), nystagmus, ataxia
Deranged mental function, fluctuates. Confusion, apathy, sleep disturbance,
disorientation, listlessness to coma
Korsakoff mostly irreversible
Retrograde (then anterograde) amnesia
Confabulation
11. Hepatic Disease
Fatty liver, hepatitis, cirrhosis, HCC
Hepatitis can range from mild with non-specific symptoms through to
jaundice and fulminant hepatic failure. Can also become chronic
Portal HTN – in setting of cirrhosis Ascites, portosystemic shunts,
congestive splenomegaly, hepatic encephalopathy
Hepatic failure – low albumin, low clotting factors, high ammonia,
peripheral stigmata, jaundice. Risk of SBP, hepatorenal & hepatopulmoary
syndromes (high mortality)
12. Hepatic Encephalopathy
Distinct from Wernicke’s; occurs in setting of pre-existing liver disease
Liver cannot cope with nitrogenous load (normally metabolises ammonium ammonia
urea, excreted via kidney).
Ammonia XBBB into astrocytes for metabolism, osmotic load cerebral oedema
Clinical features: hepatic flap, confusion, altered cognition / coma
Prevention – minimise protein / nitrogen load e.g. low protein diet, enemas, Aims for 3-4 soft
stools daily. Antibiotics ***
Lactulose – decreases transit time through gut (less absorption) and reduces production of
nitrogenous waste by gut flora. (PO or PR 30mls tds)
13. Varices
Oesophageal varcies – lower 1/3 of oesophagus venous drainage via gastric vein
vein to portal system. Develop in setting of portal HTN
Treatment of acute bleed
Careful resuscitation (Hb 70-80)
Terlipressin on suspicion of varices (don’t wait for confirmation) 2mg IV (4 hrly up to 3-5
days)
Endoscopy – banding ligation > sclerotherapy within 12 hrs presentation
Antibiotic to prevent gram negative infection – quinolone or 3rd gen ceph
Balloon tamponade with Blakemore tube (pt is intubated). Risk of oesophageal necrosis
/ rupture http://www.youtube.com/watch?v=imFCMWeWDpU
TIPSS / surgery
14. Toxic Alcohols
Methanol: >0.5ml/kg can be lethal
metabolised to formic acid, toxic to ocular tissues; CNS effects; initially elevated osmolar gap, then
HAGMA (although normal values don’t exclude significant toxicity)
Chemical thinners, paints, wood spirits, varnishes (not found in methylated spirits in Australia)
Ethylene glycol: >1mg/kg can be lethal
Metabolised to oxalic acid; HAGMA & osmolar gap; rapid CNS depression; formation calcium oxalate
crystals in tissues with hypoCa++ & renal failure, cardiorespiratory failure
Solvents, coolants, anti-freeze, brake fluids
* Treatments include ethanol, fomepizole (ADH inhibitor), NaHCO3, haemodialysis.
15. Summary
Alcohol related illness is a huge part of the ED workload burden
Management of acute intoxication is largely supportive
Higher risk, higher suspicion in trauma with alcohol on board
Acute withdrawal – manage with benzos and thiamine supplementation
Disease associated with thiamine deficiency – may be reversible
Chronic disease related to alcohol – every bodily system. Emergencies to
consider include liver failure, encephalopathy, bleeding varices
Toxic alcohol ingestions can be potentially lethal if not managed early
17. Question 1
Who coined the following phrase?
“Alcohol – the cause and solution to all of life’s problems”
18. Question 2 & 3
2) What city was the bar from this TV show set it?
3) The theme song was Where Everybody Knows You
Name. What was the name of the bar’s proprietor?
19. Question 4
Who is this handsome fella, and what is his contribution to
alcohol related medicine?
(Hint: he produced a thesis entitled Alcoholic Paralysis)
20. Question 5
This unfortunately named singer famously sang about her
refusal to enter rehab.
What was her cause of death?
21. Question 6
This well loved Australian icon reportedly died from alcohol
related dementia (or HIV according to Derryn Hinch).
Who is he and why was he booted off Australian television in
1975?
(I will give bonus points for an impression of the event)
22. Question 7
What are the alcoholic components of a traditional Long Island Iced Tea?
(Hint: there are five)
23. Question 8
On September 19, 1975, the Star Hotel in Newcastle was closed down by
police resulting in an infamous riot (ordinary fare in Newie, really). Which
famous Australian band wrote the song ‘Star Hotel’ about this event?
24. Question 9
For Game of Thrones Fans…
What type of drink does Tyrion Lannister like with his breakfast?
25. Question 10
Robert Downey Jnr is quoted as saying he has an allergy to alcohol. What
does he break out in if he drinks?
26. Question 11 & 12
11) Tom Cruise starred in the 1988 movie Cocktail. What style of bartending
did he help make famous?
12) Which Beach Boys song was the title track to the film?
27. Question 13
You can get it any old how, matter o’ fact, I’ve got it now!
Which famous Aussie beer is this the advertising slogan for?
28. Question 14
On which day of the year is St Patrick’s Day celebrated?
(Bonus point if you know why)
WHO data:
http://www.who.int/substance_abuse/publications/global_alcohol_report/profiles/aus.pdf?ua=1
http://www.who.int/mediacentre/factsheets/fs349/en/
ACEM
https://acem.org.au/getmedia/3c816a16-f4c9-4e1c-a66a-7a25df114955/ACEM_Alcohol_Harm_Survey_Media_Release_AUS181213.pdf.aspx?ext=.pdf
Article:
*Intravenous 09% sodium chloride therapy does not reduce length of stay of alcohol-intoxicated patients in the emergency department: A randomised controlled trial. Perez, Keijers, Steele, Byrnes et al. J Em Med Aust; (2013) 25,527-34.
Link to article: prospective study to determine superiority of NEXUS vs CCS rules in trauma in NEJM
http://www.nejm.org/doi/full/10.1056/NEJMoa031375
Screen using AWS – this is a validated tool
Treat with long acting benzodiazepine e.g. PO/IV diazepam
Replace thiamine e.g 100mg PO/IV daily
DT is a medical emergency with a large differential diagnosis (stroke, sepsis, thyrotoxicosis, co-ingestion etc etc). Managed as inpatient.
Other considerations – overall nutrition, social welfare
Good chapter in Toxicology Handbook 2nd ed – Alcohol Abude, Dependence and Withdrawal p85 (Chapter 2.12)
NB effects of thiamine deficiency e.g. wet beriberi / cardiac failure are distinct from the direct toxic effects of alcohol e.g. alcoholic cardiomyopathy
Wernicke encephalopathy is distinct from hepatic encephalopathy.
Wernicke’s is caused by deficiency of thiamine and can be improved or reversed with supplemental thiamine;
Hepatic encephalopathy occurs where there is pre-existing liver disease (which may or may not be alcohol related). Usually nitrogenous waste build up which the diseased liver cannot process leads to cerebral oedema and features of encephalopathy. Mainstay of treatment is correcting underlying causes, and reducing nitrogenous load e.g. low protein diet, use of enemas and lactulose to reduce nitrogen absorption and waste formation by gut flora.
CIRRHOSIS
Severity can be graded using Child-Pugh classification system.
Predicts prognosis, need for treatment and assessment for liver transplantation.
Also used in chronic liver disease.
Measures include: bilirubin, albumin, PT/INR, ascites, hepatic encephalopathy. Each is scored and then converted to a grade A/B/C
HEPATITIS
Mild, non specific
Severe, jaundice with altered LFTs
Fulminant hepatitis Also assoc coagulopathy, CVS instability, ARF, ARDS, acid base / electrolyte disturbances. Will not necessarily have chronic stigmata. Fulminant hepatitis – jaundice, encephalopathy, fetor hepaticus. Mortality approaches 90%.
Chronic (>6/12 duration with LFT derangement, confirmed histologically)
JAUNDICE
Imbalance between bilirubin production and elimination
Excessive production
Reduced hepatocyte uptake
Impaired conjugation
Decreased hepatocellular excretion
Impaired bile flow (intra & extra hepatic)
PORTAL HYPERTENSION
Resistance to flow through the portal system. May be prehepatic, intrahepatic, extrahepatic.
Cirrhosis is the most common cause in Western cultures. Also cause by portal vein thrombosis, Budd Chiari, schistomiasis
SPONTANEOUS BACTERIAL PERITONITIS
High mortality if not recognised early
Occurs in the setting of clinically appreciable ascites
Fever (although can by mildly hypothermic)
Abdominal pain / tenderness – although abdomen is rarely rigid.
Altered mental status – can be very subtle
Also – diarrhoea, paralytic ileus, hypotension
Translocation of gram negative gut flora
Rx – early resuscitation, gram negative antibiotic cover, asicitic tap (check plt and coags first!)
Triggers include GI bleeds, TIPSS, dehydration, electrolyte imbalance, drugs/alcohol/analgesics, diuretics, renal failure
Treatment also consists of correcting any underlying precipitants
Primary prophylaxis – endoscopic ligation and non selective beta blocker. Repeat scopes until confirmation that varices are healed.
Terlipressin
Vasoconstrictor. Prodrug of vasopressin
Use with caution in unstable angina / MI. Can cause bronchospasm
Octreotide is an alternative
Should be used in conjunction with endoscopic therapy
Meta-analysis shows that use of vasoconstrictors decrease 7 day mortality, improve haemostasis, decrease transfusion requirement, decrease duration of hospitalisation.
Banding ligation is superior to sclerotherapy
Sclerotherapy may be tried if ligation fails or is not possible. PPI should then be given to prevent ulceration at injection site.
Concomitant use of vasoconstrictor is superior than either method alone.
If patient has early rebleed (<6/52) – consider use of Blakemore tube in an intubated patient (high risk aspiration) as temporising measure while preparing for TIPSS procedure (transjugular intrahepatic portosystemic shunt) or surgery.
Toxic alcohols are often co-ingested with ethanol.
Fantastic review article on toxicology of methanol:
Barceloux DG, Bond R, Krenzelok EP et al. American Academy of Clinical Toxicology practice guidelines on the treatment of methanol poisoning. Journal of Toxicology – Clinical Toxicology 2002; 40(4):415-446
Fomepizole is an alcohol dehydrogenase inhibitor, not currently available in Australia. Used in methanol & ethylene glycol poisonings.
Ethanol blocks formation of toxic metabolites in toxic alcohol ingestions as it has higher affinity for alcohol dehydrogenase (x50 in article above, x20 according to tox handbook). Loading dose ‘3x40ml shots of vodka in 70kg adult omit loading dose in already intoxicated patients, then 1x40ml shot every hr thereafter. Toxic alcohols are then not metabolised and are excreted unchanged by kidney.