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Protocolos de Manejo del Paciente Intoxicado
Abstract and Figures
Segunda edición actualizada de la obra titulada: “Protocolos de Manejo del Paciente Intoxicado”.
En esta edición se actualiza lo pertinente en las instrucciones de manejo operativo y práctico para la atención clínica de los pacientes intoxica- dos, que se escribieron en la primera edición. Como ha sido tradición, la mayoría de los autores son los profesores, estudiantes y egresados de nuestra especialidad médico quirúrgica en Toxicología Clínica, pro- grama acreditado en alta calidad por el Ministerio de Educación en diciembre de 2016, además de algunos profesionales del CIEMTO.
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... El consumir marihuana, produce inicialmente relajación, sensación de bienestar, modificaciones en la captación, como aumento en la consciencia de los sentidos y la sensación de enlentecimiento del tiempo, y dificultad de memoria. (33) La intoxicación moderada o prudente, produce cambios de humor, carencia de memoria significativa y pérdida de personalidad. (33) Se ha puntualizado que la marihuana causa lo siguiente: ...
... (27) En niños pequeños, la ingestión aguda de cannabis puede provocar obnubilación, taquicardia mayor a 150 lpm, apnea, cianosis, bradicardia, hipotonía y opistótonos. (33) Con la ingestión crónica pueden notarse deficiencias para manejar, problemas en la función pulmonar y daños pre-cancerosos pulmonares por contener carcinógenos e irritantes como el benzo(e) pireno, benzo(a)pireno, benzoantraceno y carbazole. Mediante estudios se ha comprobado que el humo producido por la marihuana colocado en los pulmones aumenta la conglomeración de carboxihemoglobina hasta 5 veces más en comparación con el humo del tabaco. ...
... (27) También produce déficit cognitivo y de aprendizaje que continúan aun cuando el consumo se ha suspendido. (33). Recientemente se han demostrado cambios en la cognición (también en niños expuestos a cannabis intraútero) y funcionamiento cerebral en sujetos con alto consumo (no en estado tóxico). ...
RESUMEN El cannabis es un grupo de sustancias químicas presentes en la planta Cannabis sativa, conocida común-mente como marihuana. El principal cannabinoide psicoactivo y el más estudiado es el tetrahidrocanna-binol (THC). Es la droga ilegal de mayor uso tanto a nivel nacional como mundial. Globalmente, se esti-ma que cerca de 180 millones de personas la usan, principalmente jóvenes, quienes representan la pobla-ción más vulnerable. Su popularidad se debe en parte a sus efectos depresores del sistema nervioso, entre los cuales se encuentran relajación, sensación de bienestar y alteraciones en la percepción además de los innumerables mitos acerca de sus aplicaciones terapéuticas, entre las cuales se encuentran alivio de dolo-res crónicos, mayor concentración, y, recientemente, se ha comentado sobre el efecto neuroprotector de algunos cannabinoides y su papel en el tratamiento de enfermedades neurodegenerativas, como la enfer-medad de Alzheimer, la Esclerosis Múltiple y la enfermedad de Parkinson, siendo esta circunstancia la razón que justifica la realización de una revisión bibliográfica acerca de los efectos verdaderamente bené-ficos y sustentados científicamente, así como de los efectos neurotóxicos que podrían presentarse a corto y largo plazo, de tal forma que ambos puedan contrastarse para llegar a una conclusión. Cannabis is a group of chemicals present in the Cannabis sativa plant, commonly known as marijuana. The main psychoactive cannabinoid and the most studied is tetrahydrocannabinol (THC). Nationally and globally, it is the most commonly used illegal drug. It is estimated that around 180 million people consume it, mainly young people, who represent the most vulnerable population.
Objective:
Intoxications in the pediatric population account for a signicant portion of the causes of care in emergency services, but they are also fatal in many cases in our country.
Methods:
Exposure to a toxic or poison and its adverse effects can become medical emergencies of great magnitude, which is why many authors consider them "multiple traumas of chemical origin." This is why the management of an intoxicated pediatric patient has a unique approach due to the diagnostic challenge that it represents.
Results:
Timely and systematized care of a pediatric patient in the context of poisoning can represent the success of timely care, correct assessment, and an adequate care process.
Conclusions:
The objective of this work is to present a general approach for the intoxicated pediatric patient regarding the initial management, the approach, and the clinical data that can guide us in the emergency department when faced with an intoxicated pediatric patient.
Introduction:
A high percentage of patients who survived poisoning will be transferred to the Intensive Care Unit (ICU) to continue their management in relation to the severity of the poisoning, and possible complications that arise in this scenario. The clinical results will depend on several factors, such as the ingested dose, the characteristics of the substance, the time of medical attention, and the pre-existing state of health of the patient.
Objective:
To review the clinical behavior of poisonings in the critically ill patient.
Recent findings:
The data bases that yielded relevant bibliographical results were Web of Sciences, Scopus, PubMed, SciELO, and bibliographic references published between 2012 and 2020 were chosen.
Conclusions:
The clinical behavior of poisonings in the critically ill patient is atypical. The intensivist must have an in-depth knowledge of the behavior and pathophysiology of the toxins since making a medical diagnosis on the stage of the critically ill patient is challenging. The integration of all possible medical tools is required to achieve this in the absence of clinical history, and the implementation of early management strategies is necessary to reach physiological restoration by using a continuous evaluation approach. The severity of poisoning in the critically ill patient demands interdisciplinary management that includes assessment by Clinical Toxicology.
Various adverse events resulting from, or associated with, benzodiazepine and/or Z-drug use have been extensively reported on and discussed in great detail within the biomedical literature. It is widely accepted that motor vehicle accidents and falls leading to fractures in older adults are major adverse events that have been shown to occur more frequently in users of sedative-hypnotic medication, especially of the benzodiazepine and related Z-drug variety. However, the last few years have seen increasing reports in the literature raising the issue of benzodiazepine and Z-drug exposure in the development of other serious medical issues including dementia, infections, respiratory disease exacerbation, pancreatitis, and cancer. This article provides an overview and interpretation on the current state of evidence regarding each of these associations and proposes what gaps in the evidence for drug-exposure–harm associations need to be addressed in the future for the purpose of evaluating causality of harm as it relates to these drugs.
The aqueous leaf extract, after six weeks administration showed a decrease in weight of the treated animals, whereas body weight of the un-treated animals rose progressively as the period increased. Phytochemical screening of the plant reveals the presence of saponins, alkaloids and volatile oils. Pathological features like congestion of the lungs, metaplastic changes in the mucosal surface of the stomach, and necrosis of the kidney tubules were noticed. These abnormalities may possibly not develop with C. ambrosioides used for a short period.
The cardiovascular consequences of cocaine use are numerous and can be severe, with mechanisms of cardiotoxicity unique to cocaine that include sympathomimetic effects, blockade of sodium and potassium channels, oxidative stress and mitochondrial damage, and disruption of excitation-contraction coupling. In combination, these effects increase myocardial oxygen demand while simultaneously decreasing oxygen supply. Cocaine-associated chest pain is particularly common and, in some instances, associated with a more severe cardiac syndrome, such as myocardial infarction, myocardial ischemia, arrhythmia, cardiomyopathy, aortic dissection, or endocarditis. Therapy for cocaine-associated chest pain and myocardial infarction is similar to treatment in non-cocaine users, except for differences in the use of benzodiazepines and phentolamine and avoidance of beta-blockers in the acute setting. In this review, we discuss the most up-to-date literature regarding the mechanisms of cocaine-associated cardiotoxicity and clinical consequences, diagnosis, and treatment; we also discuss relevant controversies while proposing several important areas for future research.
Copyright © 2014 Elsevier Inc. All rights reserved.
Interest and information in the field of medical toxicology has grown rapidly, but there has never been a concise, authoritative reference focused on the subjects of natural substances, chemical and physical toxins, drugs of abuse, and pharmaceutical overdoses. Medical Toxicology of Natural Substances finally gives you an easily accessible resource for vital toxicological information on foods, plants, and animals in key areas in the natural environment.
With each successive year, the number of Emergency Department (ED) visits related to illicit drug abuse has progressively increased. Cocaine is the most common illegal drug to cause a visit to the ED. Cocaine use results in a variety of pathophysiological changes with regards to the cardiovascular system, such as constriction of coronary vessels, dysfunction of vascular endothelium, decreased aortic elasticity, hemodynamic disruptions, a hypercoagulable state, and direct toxicity to myocardial as well as vascular tissue. The clinical course of patients with cocaine-induced chest pain is often challenging, and electrocardiographic findings can be potentially misleading in terms of diagnosing a myocardial infarction. In addition, there is no current satisfactory study regarding outcomes of use of various pharmacological drug therapies to manage cocaine associated chest pain. At present, calcium channel blockers and nitroglycerin are two pharmacological agents which are advocated as first-line drugs for cocaine-induced chest pain management, while the role of labetalol has been controversial and warrants further investigation. We performed an extensive search of available literature through a large number of scholarly articles previously published and listed on Index Medicus. In this review we put forward a concise summary of the current approach to a patient presenting to the ED with cocaine associated chest pain, and management of the clinical scenario. The purpose of this review is to summarize the understanding of cocaine's cardiovascular pathophysiology, and examine the current approach for proper evaluation and management of cocaine-induced chest pain.