Topics in Toxicology and Wilderness version 1

This book comprises a subset of the topics prepared by the Emergency Medicine expert writing group for the electronic product eTG complete. As resuscitation is essential to all aspects of emergency medicine, that section is reproduced in full as an introduction. Otherwise the main focus of the book is toxicology, toxinology, anaphylaxis and wilderness (environmental) medicine, including assessment and management of burns. There is also a limited amount of clinical pharmacological information about drugs used in the management of poisoning.

Resuscitation
Toxicology: general approach
Toxicology: specific drug treatments and antidotes
Toxicology: toxidromes
Toxicology: paediatric poisoning
Toxicology: individual drugs and other chemicals
Toxinology
Anaphylaxis
Wilderness (environmental) medicine
Appendices

Resuscitation

• Airway
  • General considerations
  • Simple measures
  • Bag-mask ventilation
  • Oral airway
  • Nasopharyngeal airway
  • Laryngeal mask airway (LMA)
  • Direct laryngoscopy and intubation
  • Emergency surgical airway
• Breathing
  • Basic resuscitation
  • Rescue breathing
  • Maintaining sedation and preparation for retrieval
  • Ventilator settings in emergencies
• Circulation
  • Cardiopulmonary resuscitation
  • Intravenous cannulation
  • Intravenous fluid rates in the seriously ill
  • Inotropes in critical situations

Toxicology: general approach

• Risk assessment
• Poisons information centres
• Key investigations
  • Electrocardiography
    • QRS widening
    • QT prolongation
  • Drug concentrations
  • Pathology tests
  • Arterial blood gases
  • Radiological imaging
• Treatment
  • Resuscitation
  • Decontamination
    • Single-dose activated charcoal
    • Whole bowel irrigation
    • Multiple-dose activated charcoal
    • Skin decontamination
    • Gastric lavage
    • Induced emesis
    • Ocular decontamination
  • Enhanced elimination
    • Extracorporeal elimination
    • Urinary alkalinisation
  • Chelation therapy
  • Specific pharmacological therapies
    • Antidotal therapy
    • Sedation
    • Anticonvulsant therapy
    • Antiarrhythmic therapy
  • Aspiration pneumonitis
• Disposition

Toxicology: specific drug treatments and antidotes

• Activated charcoal
• Acetylcysteine
• Cyproheptadine
• Desferrioxamine
• Dicobalt edetate
• Digoxin-specific antibodies
• Flumazenil
• Glucagon (use in toxicology)
• Pralidoxime
• Thiamine
• Naloxone

Toxicology: toxidromes

• Anticholinergic (antimuscarinic) agents
• Cholinergic agents
• Methaemoglobinaemia
• Neuroleptic malignant syndrome
• Serotonin toxicity
• Sympathomimetic syndrome and catecholaminergic agents

Toxicology: paediatric poisoning

• Epidemiology
• Estimation of ingested dose in children
• Decontamination in children

Toxicology: individual drugs and other chemicals

• Alkali ingestions
• Amisulpride
• Amphetamines, methylphenidate and cocaine
• Angiotensin converting enzyme (ACE) inhibitors and angiotensin II antagonists
• Antihistamines, less sedating
• Antihistamines, sedating
• Antipsychotics
• Antipsychotics, typical
• Aspirin
• Baclofen
• Benzodiazepines
• Benztropine, benzhexol
• Beta blockers
• Bupropion
• Caffeine
• Calcium channel blockers
• Carbamazepine
• Carbon monoxide
• Chloroquine and hydroxychloroquine
• Clonidine
• Colchicine
• Cyanide
• Digoxin
• Essential oils
• Flecainide
• Gamma-hydroxybutyrate
• Glyphosate
• Hydrofluoric acid (hydrogen fluoride)
• Insulin
• Iron
• Isoniazid
• Lithium
• Metformin
• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Opioids
• Organophosphates
• Paracetamol
• Phenytoin
• Potassium
• Pseudoephedrine
• Selective serotonin reuptake inhibitors (SSRIs)
• Sodium valproate
• Sulfonylureas
• Theophylline
• Tramadol
• Tricyclic antidepressants
• Venlafaxine
• Warfarin poisoning and over-anticoagulation
• Summary tables of other common and/or serious poisonings

Toxinology

• Snake bite
  • Clinical effects
  • Clinical syndromes
  • First aid
  • Hospital management
  • Diagnosis
  • Treatment of snake bite
• Spider bite
  • Funnel-web spider bites
  • Red-back spider bites
• Marine envenoming
  • Jellyfish stings
  • Penetrating venomous marine injuries
  • Sea snakes
• Marine poisoning
  • Ciguatera
  • Tetrodotoxin poisoning
  • Scombroid
  • Other marine poisoning
• Tick bite

Anaphylaxis

• Classification and severity
• Emergency management of allergic and anaphylactic reactions
  • Mild allergic or anaphylactic reactions
  • Moderate or severe anaphylactic reactions
• Prevention of further anaphylactic reactions

Wilderness (environmental) medicine

• Altitude illness
• Burns
• Diving medicine
• Electrical injury
• Heat-related illness
• Hypothermia
• Near-drowning and submersion injury

Appendices

• Australian resuscitation guidelines
• Glasgow Coma Scales
• Therapeutic hypothermia
• Useful resources
• Common abbreviations in emergency medicine

Electronic version

Therapeutic Guidelines: Toxicology and Wilderness is available in electronic format as part of eTG complete.