Multiprofessional Critical Care Review: Pediatric 2024 (MCCRCP24ON)-Evaluation and Management of Poisoned Child

Evaluation and Management of Poisoned Child

Pdf Summary

The document titled "The Evaluation and Management of the Poisoned Child" by Dr. Edward E. Conway Jr. provides a comprehensive guide for medical professionals to manage pediatric toxicology cases. It underscores the unique challenges in pediatric toxin susceptibility due to developmental changes, higher dermal absorption, metabolic rate, limited cardiovascular reserve, and maturing neurotransmitter receptors.<br /><br />The debrief includes steps to approach unknown ingestions, focusing on a detailed toxicological physical examination which assesses vital signs, pupillary diameter, nystagmus, mucous membranes, skin moisture and color, mental status, muscle tone, reflexes, clonus, bowel sounds, and bladder distension. Identifying and managing life-threatening issues in neuro, respiratory, and cardiovascular systems are critical, with specific attention to seizures, coma, respiratory failure, ARDS, tachycardia, dysrhythmias, hyperthermia, and resultant complications like cerebral edema and myocardial dysfunction.<br /><br />Laboratory tests, including urine toxicology and ECG changes, assist in diagnosis. Treatment protocols for specific toxins such as acetaminophen (use of N-acetylcysteine to detoxify NAPQI), sulfonylureas, methemoglobinemia, calcium channel blockers, and beta-blockers are discussed. Noteworthy are advanced therapeutic approaches like Hyperinsulinemic-Euglycemic Therapy (HIET) for cardiogenic shock from calcium channel blocker overdose, and lipid emulsions as antidotes for local anesthetic and certain drug toxicities.<br /><br />Various antidotes are explored, such as glucagon for beta-blocker and calcium-channel overdose, which works by circumventing poisoning of the Beta 1 receptor, and fomepizole for ethylene glycol poisoning, blocking the metabolism of toxic metabolites. The guide also highlights critical points like prioritizing the treatment of severe hyperthermia, managing poisoning-induced hypertension with benzodiazepines and hypotension with norepinephrine, and notes the inaccuracies in urine toxicology screens, recommending the USA Poison Center (1-800-222-1222) for support.<br /><br />The document is an extensive resource aimed at enhancing the management standards for pediatric poisonings through structured examination, identification of critical symptoms, strategic use of laboratory tests, and applying specific antidotes and advanced treatment methodologies.

Keywords

pediatric toxicology

poisoned child management

toxicological physical examination

life-threatening issues

treatment protocols

antidotes

Hyperinsulinemic-Euglycemic Therapy

lipid emulsions

urine toxicology

USA Poison Center

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