Emergency Department

General principles of poison management apply to the initial approach to patients once they reach the hospital. Establishing the airway and maintaining ventilation is the critical first maneuver in any patient who presents with respiratory depression and/or significant CNS depression. The detection of a sweet odor may be associated with certain halogenated hydrocarbon exposures (especially chloroform or trichloroethylene) while a petrol odor suggests gasoline or some other petroleum derivative. The patient should be connected to a continuous cardiac monitor and an electrocardiogram should be obtained. Hydrocarbon-induced dysrhythmias, if present, would generally occur shortly after the exposure, especially with inhalational use. Hypotension should be treated with aggressive fluid resuscitation. Catecholamines, such as dopamine, norepinephrine, or epinephrine, should be avoided to prevent precipitating dysrhythmias, especially following exposure to halogenated hydrocarbons and aromatic hydrocarbons. The administration of glucose, thiamine, and naloxone should be considered in cases of altered mental status. (See Table 174-5.)

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