Tag Archives: toxicology

Do all comatose patients need intubation?

In non-trauma patients, do you base your decision to intubate patients with decreased conscious level on the GCS? These guys in Scotland describe a series of poisoned patients with GCS range 3-14 managed on an ED observation unit without tracheal intubation, with no demonstrated cases of aspiration. They say: ‘This study suggests that it can be safe to observe poisoned patients with decreased consciousness, even if they have a GCS of 8 or less, in the ED‘. Small numbers, but gets you thinking. This subject would make a great randomised controlled trial.
Decreased Glasgow Coma Scale score does not mandate endotracheal intubation in the emergency department
J Emerg Med. 2009 Nov;37(4):451-5

Take bloods before giving Lipid Rescue

Intralipid therapy is recommended for local anaesthetic toxicity and in some overdoses. After large doses of Intralipid, the results of blood tests may be difficult to analyse, delayed, or spuriously abnormal. If possible, all blood tests should be taken before the administration of Intralipid. While laboratories will readily identify significant lipaemia, communication about the presence of Intralipid is important. In one case, the inability to obtain a haemoglobin result led to delay in the identification of haemorrhage which was the cause of deterioration initially thought to be local anaesthetic toxicity.
Possible side effects of Intralipid rescue therapy
Anaesthesia 2010;65(2):210-11

Levosimendan in beta blocker overdose

Not a human study, but toxicology RCTS rarely are…
Levosimendan – a calcium sensitiser with inotropic properties, was superior to dobutamine and to saline placebo in the end points of survival, cardiac output, and mean arterial pressure in anaesthetised pigs with propranolol overdose.
Levosimendan as a Rescue Drug in Experimental Propranolol- Induced Myocardial Depression: A Randomized Study
Ann Emerg Med. 2009 Dec;54(6):811-817