Getting some of the rarer antidotes has recently been clarified across Yorkshire (Accessing rarely used antidotes-SOP)
Category: Toxicology
Suspected Contamination Incident – HAZMAT
So a patient comes to ED after white powder thrown is at them what do you do? Your initial response can help them and everyone in the department!
- Ask them to leave the department
- Going to garage was useful
- Inform Nurse in Charge and Consultant
- Dynamic risk assessment
- Performed by nursing/medical staff while outside
- Decontaminate
- Non-caustic chemicals: Dry decontamination
- Caustic, Biological, Radiological: Wet decontamination
- Retain clothing and wipes, double bagged as evidence/disposal
- Return to ED
If you haven’t seen the Initial Operational Response (IOR) training video please watch it.
The patient can then be thoroughly assesses, to identify the substance involved (this may involve witnesses, police info and symptomatology), and treated appropriately.
- Public Health England are a useful source of advice.
- Organophophate/Nerve agent – PHE
Police should be informed of the incident for several reasons: 1. Public safety, 2. To collect the evidence and possible find out what it was for you. (if this is not a criminal act Public health England can advise on return/disposal of personal effects)
Inform Manager On-Call of incident as it may disrupt the functioning of ED and can provide support.
Patient symptom-free and substance unknown
In our recent case Public Health England advised
- 4-6hr observation
- Discharge with advice:
- “if developing symptoms to return to the ED via ambulance but the patient must be aware that they must inform 999 of the original exposure.”
Resourses
- Public Health England (PHE) Advice – Lines
- PDF: PHE – Organophosphate – Inc. signs/symps and management of organophosphate poisoning & chain of evidence form
- Action Card – mobile patients
- NHS England (HAZMAT/CBRN) – inc. national stocks
- Home Offices (2015)
- Disrobing – pg 20
- DRY decontamination – pg 21
- WET decontamination – pg 22
Button Battery Ingestion
A button battery lodged in the Oesophagus is a medical emergency as it can cause necrosis and significant GI bleed – Refer immediately
If anybody is symptomatic after button battery ingestion they need referral to the Surgical team for urgent endoscopic removal Read more
Alcohol Withdrawl
Generally we DON’T admit patients acutely solely for “Detox”
However the following groups should be admitted [taken from trust guide]
- Patients requiring admission for another reason – refer to appropriate specialty (e.g. Head injury going to CDU, or Upper GI bleed going to medicine)
- ALL patients with symptoms / signs of Wernicke’s – medicine
- ALL patients with Delirium Tremens – medicine
- ALL alcohol withdrawal fits if patient to remain abstinent – medicine
- ALL alcohol related seizures with possible other trigger – medicnie
- ALL decompensated alcoholic liver disease – medicine
If admitted to CDU – complete the PAT tool
Scombroid Poisoning- NOT another fishy allergy
Scombroid poisoning (AKA – Histamine fish poisoning) is apparently more common than we think and accounts for 40% of seafood related illness in the USA according to the CDC. But Scombriod poisoning is missed as its put down to allergy. Read more
Drugs & Alcohol misuse in young people
Ending up in the ED as a result of alcohol and or substance use is NOT normal behaviour
- Children who use alcohol or other substances are hugely vulnerable to sexual exploitation and other forms of abuse.
- The use of alcohol or drugs can be encouraged as part of the grooming process, or as a means of coping with a difficult situation for the young person.
- It is also likely that friends and close acquaintances of the young person are equally vulnerable.
LA – Toxicity
We are regularly doing femoral blocks next to major vessels. So warn the patient of the symptoms, & keep them monitored(at least 15 min).
Symptoms of local anaesthetic toxicity
- Circumoral and/or tongue numbness
- Metallic taste
- Lightheadedness/Dizziness
- Visual/Auditory disturbances (blurred vision/tinnitus)
- Confused/Drowsiness/Fitting
- Arrhythmia
Remember – Do basics WELL
- Intralipid – in emergency drug cupboard
- Bolus – 1.5ml/kg 20% lipid solution over 1min
- also start Infusion – 15ml/kg/hr 20% lipid solution
PDF:la_tox
