Date post: | 18-Apr-2017 |
Category: |
Documents |
Upload: | ronald-chrisbianto |
View: | 213 times |
Download: | 0 times |
Ronald Chrisbianto Gani405090223
Faculty of MedicineTarumanagara University
EMERGENCY MEDICINE BLOCK
HYDROCARBON POISONING
HYDROCARBON POISONING
Rosen’s Emergency Medicine 7th Ed
PATHOPHYSIOLOGY
• Three main target organs– Lungs, CNS, Heart
• Cause most damage via lungs• Charactristics– Lower the viscocity, higher the toxicity– High volatility, enable to displace alveolar oxygen– Low surface tension, susbtance disperse easily– Chemical side chains often increase toxicity
Rosen’s Emergency Medicine 7th Ed
PATHOPHYSIOLOGY
• Lung– Bronchospasm and inflammation– Displace oxygen in alveolar hypoxia– Direct injury to pulmonary alveoli and cappilaries
distict uniform lesion– Inhibit surfactant function alveolar collapse
• CNS – Depression– Respiratory pulmonary alveoli blood and tissue
euporia, disinhibiton, confusion, obtudantion
Rosen’s Emergency Medicine 7th Ed
PATHOPHYSIOLOGY
– Chronic use peripheral neuropathy, cerebelar degeneration, neuropsychiatric disorders, chronic encephalopathy, dementia
• Cardiac– Sudden death– Myocardial sensitization ventricular dysrhytmia
and myocardial dysfunction
Rosen’s Emergency Medicine 7th Ed
CLINICAL FEATURES
• Child ingest unknown amount of HC– Cyanosis, coughing, grunting, noisy respirations,
repeated bouts of vomit– Tachypnea, dyspnea, bronchospasm, wheezing,
rales, fever– Change in mental status– Extreme : respiratory failure
Rosen’s Emergency Medicine 7th Ed
CLINICAL FEATURES
• Solvent-abuse adolescent or adult– Cardiac arrest– CNS intoxication (euphoria, agitation,
hallucinations, confusion, bizzare behavior) CNS depression and seizure
– Long term : peripheral neuropathy, cerebelar degeneratio, encephalopathy
Rosen’s Emergency Medicine 7th Ed
CLINICAL FEATURES
• Accidental dermal or inhaled respiratory exposure– Not life-threathening– Asymptomatic or transient symptoms (headache,
dizziness, nausea)– Skin : erythema, swelling, blistering, dermal
destruction
Rosen’s Emergency Medicine 7th Ed
DIAGNOSIS
• History and PE for aspiration• Significant HC exposure (tachypnea,
tachycardia, wheezing, hypoxemia) chest radiograph
• Continuous pulse oxymetri and ABG• Chronic users behavioral problems
exclude underlying disease
Rosen’s Emergency Medicine 7th Ed
CXR
Rosen’s Emergency Medicine 7th Ed
MANAGEMENT
• All patients must be monitored by cardiac monitors and pulse oxymetri
• Intubation needed in severe cases• High frequency jet ventilation and exreacorporeal
membrane oygenation children with respiratory failure secondary to aspiration
• Surfactant therapy • Supportive care and close observation, no specific
antidotes
Rosen’s Emergency Medicine 7th Ed