Pre0003-Lapostolle Frederic · Urgences - SAMU 93, UF Recherche Hôpital Avicenne & Université...
Transcript of Pre0003-Lapostolle Frederic · Urgences - SAMU 93, UF Recherche Hôpital Avicenne & Université...
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Frédéric LapostolleUrgences - SAMU 93, UF RechercheHôpital Avicenne & Université Paris 13, Bobigny
Disclosures SpeakerAstra-Zeneca, Bayer, BMS, Boehringer-Ingelheim, Daiichy-Sankyo, Lilly,Medtronic, Merck-Serono, Mundipharma, Novartis, Pfizer, Teleflex, TheMedicine Company
Investigator
Astra-Zeneca, Merck-Serono, Mundipharma, Novartis, Teleflex
Frédéric LapostolleUrgences - SAMU 93, UF RechercheHôpital Avicenne & Université Paris 13, Bobigny
Frédéric LapostolleUrgences - SAMU 93, UF RechercheHôpital Avicenne & Université Paris 13, Bobigny
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Human Toxicity Excerpts:/SIGNS AND SYMPTOMS/ Ingestion of five or more grams of nutmeg causes acute nutmeg poisoning, whichincludes giddiness, hallucinations, and feelings of depersonalization. Symptoms usually appear three to six hours after ingestion of 1‐3 whole nutmegs or 5‐15 gm of the grated spice. Recovery usually occurs within24 hours. Nevertheless, duration of action may extendbeyond several days and even include death. /Nutmeg/[Green RC, Jr; JAMA 171 (10): 1342‐4 (1959); Painter JC et al; Clin Toxicol 4 (1): 1‐4 (1971)] **PEER REVIEWED**
Human Toxicity Excerpts:/SIGNS AND SYMPTOMS/ Ingestion of five or more grams of nutmeg causes acute nutmeg poisoning, whichincludes giddiness, hallucinations, and feelings of depersonalization. Symptoms usually appear three to six hours after ingestion of 1‐3 whole nutmegs or 5‐15 gm of the grated spice. Recovery usually occurs within24 hours. Nevertheless, duration of action may extendbeyond several days and even include death. /Nutmeg/[Green RC, Jr; JAMA 171 (10): 1342‐4 (1959); Painter JC et al; Clin Toxicol 4 (1): 1‐4 (1971)] **PEER REVIEWED**
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Boyer, NEJM, 2005 Boyer, NEJM, 2005
Serotoninsyndrome
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Coma
Bradypnea
Myosis
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Diagnostic strategy Diagnostic strategy
Diagnostic strategy Diagnostic strategy
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Diagnostic strategy Diagnostic strategy
Diagnostic strategy
It’s not a poisoning
There is another toxic (to identify)
There is a complication (to identify) Myosis
Normal blood
pressure
Normal heartrate
Normal EKG
Myosis
Normal blood
pressure
Normal heartrate
Normal EKG
Rhabdomyolysis
Aspiration
Interaction with diagnostic, severity and outcome
Rhabdomyolysis Aspiration
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Myosis
Normal blood
pressure
Normal heartrate
Normal EKG 2
Congruence =
Security
Congruence =
Security
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3 ‘’Result likely to influence treatment’’Proudfoot, Critical Care Toxicology, 2005
3 ‘’Result likely to influence treatment’’Proudfoot, Critical Care Toxicology, 2005
3Acetaminophen
Carboxyhemoglobin
Digoxin
Ethylene glycol
Iron
Lithium
Isopropanol
Methanol
Methemoglobin
Phenobarbital
Salicylates
Theophylline
Proudfoot, Critical Care Toxicology, 2005
3Acetaminophen
Carboxyhemoglobin
Digoxin
Ethylene glycol
Iron
Lithium
Isopropanol
Methanol
Methemoglobin
Phenobarbital
Salicylates
Theophylline
Proudfoot, Critical Care Toxicology, 2005
Brent, NEJM, 2009 Brent, NEJM, 2009 Finkle, Acid-base and Electrolyte disorders, 2002
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Equimolar “curative” neutralization AsystoleVentricular dysrhythmiaHeart rate < 40/min after intravenous atropineSerum potassium > 5.0 mmol/L
Semi-equimolar “prophylactic” neutralization Age>55Cardiac diseaseHeart rate <60/min after atropineSecond or third degree block Serum potassium > 4.5mmol/L
Lapostolle, Crit Care Toxicology, 2005
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Supportive treatment
Decontamination / drug removal
Antidote treatment
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Clinical Toxicol, 2005 Clinical Toxicol, 2005
Clinical Toxicol, 2005 Clinical Toxicol, 2004
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Clinical Toxicol, 2004
Antidotes
Antidotes with alternative treatment
Antidotes with alternative treatment Antidotes with alternative treatment
Antidote without alternative treatment
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Simmons, Drug Alcohol Depend, 2017
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Dart, Ann Emerg Med, 2017
Dart, Ann Emerg Med, 2017California Health and Human Services Agency Department of Public Health. Hospital Administrative Penalties
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Make exceptional treatment available
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Make exceptional treatment available
www.saitonjamais.be
www.saitonjamais.be
1&2The doubt kills
www.saitonjamais.be
1&2The doubt kills
3
Toxicologic screening is not useful
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www.saitonjamais.be
1&2The doubt kills
3
3Make exceptional treatment available
Toxicologic screening is not useful
www.saitonjamais.be