Environmental / Toxicology II block (August 2017)
Research: Wu, Peter. et al. “Carbon Monoxide Poisoning.” Canadian Medical Association Journal, 2014.
Research: Atha, Walter F. “Heat-Related Illness.” Emerg Med Clin N Am, 2013.
AIR: Toxicology II
For a Review Article
- How has reading the article changed your practice?
- What information had you believed in previously that were debunked by reading this article?
- What new information did you learn from reading this article?
- What are current areas of uncertainty on this topic that can be potential areas for research?
For an Original Research Article
- What are some strengths of the study?
- What are the limitations?
- What are the main outcomes of the study?
- Does reading this article change your practice? If so, how?
8 comments
Definitely check out the short real concise review of CO poisoning by Wu et al. Talk about high yield!
The Heat related illness particle has a lot of pathophys you can review in detail, or not. But make sure you focus on the management aspects in terms of how to best lower body temperature.
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Another concise and helpful review on core content.
The heat illness article mentions evaporative cooling. Usually we don’t have large industrial fans and this is more challenging to use.
I have used the Arctic Sun (same device used for therapeutic hypothermia) now for several patients with heat stroke and severe hypothermia. There are several case reports describing this application and it is my recommendation as controlled cooling with precise control.
See blog by Paul Auerbach = https://www.outdoored.com/blogs/treating-severe-heatstroke-external-cooling-system
Clin Exp Emerg Med. 2014 Sep 30;1(1):62-64. eCollection 2014 Sep.
Use of an external-cooling device for the treatment of heat stroke.
Lee BC1, Kim JY1, Choi SH1, Yoon YH1.
Wien Klin Wochenschr. 2014 Aug;126(15-16):491-4. doi: 10.1007/s00508-014-0531-7. Epub 2014 Mar 25.
Life-threatening heat stroke presenting with ST elevations: a report of consecutive cases during the heat wave in Austria in July 2013.
Lassnig E1, Dinkhauser P, Maurer E, Eber B.
typo in my note above “hypothermia” should be “hyperthermia”
CO poisoning: Nice and concise; a great reminder; such a nonspecific presentation. How many dizzy patients do we get a day??? This is a good reminder to remember to ask about possible CO exposure, and not just in the colder months. Good reminder about not using amyl nitrite and sodium nitrate in concurrent CO poisoning to not make things worse.
CO article:
1) I’ll keep in mind that residential fires can produce both CO and cyanide poisoning, so patient’s should be evaluated for both.
2) I knew that the pulse oximeter will read normal for CO poisoning, but hadn’t previously considered that the ABG will also be normal (though it makes sense)
3) Nitrite treatment should be avoided in concurrent CO and CN poisoning.
4) Are there mortality/morbidity benefits for hyperbaric oxygen therapy in CO poisoning?
CO poisoning
Great brief review, most important take away is to consider concomitant cyanide toxicity and to avoid amyl nitrite and sodium nitrate in these patients. Things I will need to look into further are more clear indications for hyperbaric therapy although CO >25% is a good start. Screen for CO poisoning in vague HAs in winter time. Also fun fact…paint strippers use methylene chloride chemicals which if inhaled can cause CO toxicity. Methylene chloride is metabolized to CO in the body so paint strippers that don’t use proper masks are at risk!
How has reading the article changed your practice?
-reconsideration of using alpha predominant pressor in hypotension in heat stroke pts although that eliminates the majority of our go to pressers (norepinephrine, epi, phenylephrine), not sure my 1st line would dopamine or dobutamine
What information had you believed in previously that were debunked by reading this article?
-poor literature for other cooling mechanisms (foley, peritoneal lavage)
What new information did you learn from reading this article?
-good relearning of the biomechanisms at play in heat stroke, I knew it at some point, good to re-learn
What are current areas of uncertainty on this topic that can be potential areas for research?
-hypothermia protocol in heat stroke