![]() Monitoring of heart rhythms and electrolytes, including calcium and magnesium, is necessary. Oral ingestion, often in the context of suicidal behavior, is likely to be fatal and may be treated with lavage. Monitoring of calcium and magnesium levels is important. Relief of pain is a good marker of the efficacy of treatment. In some circumstances, intradermal or intraarterial injections of calcium (gluconate strongly preferred) have been used. When applied, the treating clinician should use barrier protection. Some have recommended benzalkonium chloride solution. HF acid, among all the exposures mentioned above, can be treated with copious irrigation and application of a paste (commercially available and often supplied in an industrial setting where HF may be used commonly or made in the emergency department with powdered calcium gluconate and surgical lubricants). There is no current recommendation of systemic medications such as steroids, antibiotics, or prophylactic renal/hepatic therapies. There is high concern about aspiration, increased tissue damage with retching, and a strong possibility of exacerbating a bad situation. It is not appropriate to introduce emetic agents or "neutralizing" agents into the treatment regimen after ingestion. Ultrasonography in experienced hands may provide answers as to location as well. It would be unusual that CT scanning would be needed, and MRI studies are interdicted. If there is concern about ingestion of disc or other flat batteries, radiographic assessment is mandated. Endoscopic examination best explores internal injuries after ingestion. Previously, a radio-opaque contrast was used, but this should be avoided in suspected perforation.Ĭopious irrigation of affected external areas is mandated. Non-contrast CT may be used if there is concern about mediastinal free air, resulting from a perforation after exposure. Radiographic studies, especially including an upright chest film, may help to determine if there is the presence of free air, which is suggestive of a perforation. With ingestions, especially when concerned about systemic absorption, laboratory evaluation (complete blood count, platelets, electrolytes, calcium, magnesium, arterial/venous blood gas, liver and kidney studies, lactic acid level, and, occasionally, coagulation studies) may be indicated. Likewise, eye injuries must be examined by an experienced ophthalmologist who will follow up with the patient sequentially and guide additional therapy. Īny gastrointestinal (GI) exposure must be seen by an experienced endoscopist who may need to perform serial evaluations to document healing. ![]() With most other topical exposures, observation and serial monitoring of changes are sufficient. In the instance of hydrofluoric (HF) acid exposure (see treatment below), monitoring of serum calcium and magnesium levels is critical to prevent chelation with the fluoride ion and cytotoxicity. Direct examination of external exposure sites is mandatory, and if there is ingestion, endoscopic evaluation is necessary. ![]()
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |