Has your patient swallowed JIK or other corrosive substance lately?

DO NOT…

  1. Panic (Doesn’t help the patient)
  2. Induce Emesis (risk of mucosal injury and perforation)
  3. Insert NG Tube (may cause esophageal perforation and increase the risk of aspiration)
  4. Do Lavage (risk of damage to oesophagus and aspiration)
  5. Try to neutralise the substance (risk of heat production resulting from this exothermic reaction
  6. Administer systemic steroids

You could instead:

  1. Pay special attention to the Airway/Oxygenation
  2. IV Fluids
  3. Add PPIs (reduce exposure of injured esophagus to gastric acid, which may result in decreased stricture formation.)
  4. Antibiotics if there is evidence of perforation
  5. Don’t forget to add pain relief
  6. Keep Nil by Mouth

When your patient turns blue after you’ve infiltrated lignocaine around their wound…think Methaemoglobinaemia

MetHb level (%)   Signs and symptoms
 1-3% (normal)
  • None
 3-15%
  • Low pulse oximetry (<90%)
  • Gray cutaneous coloration
 15-20%
  • Chocolate brown blood
  • Cyanosis
 20-50%
  • Dizziness, syncope
  • Dyspnea
  • Weakness
  • Headache
 50-70%
  • CNS depression, coma, seizure
  • Dysrhythmias
  • Tachypnea
  • Metabolic acidosis
 >70%
  • Death
  • Hypoxic injury

For all those organophosphate poisonings…

 

Physostigmine

We recommend 1-2 mg (0.05 mg/kg, maximum initial dose of 0.5 mg in children) IV slow infusion over at least 5 minutes to reduce the risk of seizures. Dose may be repeated for incomplete response after 5 to 10 minutes up to a maximum of 2 mg in children and 4 mg in adults. Always have atropine and a benzodiazepine at bedside in case of significant cholinergic excess symptoms or seizures, respectively. Response to physostigmine can occur rapidly (within minutes), but the duration of effect of physostigmine tends to be shorter than that of antimuscarinic agents. Observe for recurrence of antimuscarinic symptoms, and assess if the patient will need repeated dosing of physostigmine.

It’s getting cold so here’s a review of carbon monoxide poisoning

“Symptoms are variable and physical exam and pulse-oximetry are unreliable. Maintain high level of suspicion with emphasis on historical factors. Start the patient on O2 as soon as the diagnosis is suspected.”