0071643192.pdf

ENVIRONMENTAL EMERGENCIES

DIAGNOSIS

■ Focuses on identifying associated injuries or abnormalities
■ CXR—if patient symptomatic
■ Cardiac monitoring
■ Electrolyte studies are rarely helpful.
■ Trauma evaluation (as indicated)

TREATMENT

■ ABCs and supportive care
■ Warm to 32–35°C.
■ Treat associated injuries or trauma.
■ Notshown to improve outcome: hyperventilation, steroids, induced coma,
prophylactic antibiotics
■ Asymptomatic patients can be discharged home after 4–6 hours of
observation.

COMPLICATIONS

■ Numerous pulmonary complications—pneumonia, pulmonary edema,
pneumonitis, ARDS
■ Hemolysis and DIC
■ Hypoxia-associated complications—CNS injury, multiorgan injury
■ Complete recovery in 48 hours is typical for patients not requiring
CPR.

POISONOUS PLANTS

Hundreds of poisonous plants exist. This section will focus on those more
commonly encountered (see Table 13.15).

Castor Bean and Jequirity Bean

The castor bean and jequirity bean (rosary pea) are from the same family and
contain potent toxalbumins (ricin and abrin, respectively). They are used for
ornamental purposes, such as in prayer or rosary beads.

MECHANISM OFTOXICITY

■ Chewing of bean →toxin absorption →inhibition of protein synthesis →
cytotoxic cellular effects.

SYMPTOMS/EXAM

■ Feveris the major presenting feature.
■ Delayed GI symptoms(6 hours to days).
■ Nausea/vomiting, abdominal pain, bloody diarrhea
■ Followed by delirium, seizures, liver and renal failure, coma, and death
■ Castor beans are antigenic and may cause severe cutaneous hypersensi-
tivity or systemic allergic reactions.

DIAGNOSIS

■ Based on history of ingestion/exposure and clinical presentation

Poor prognostic factors:

Age <3 years

Delay in initiation of CPR

>5 minutes submersion time

Acidosis

GCS 3

Need for ongoing CPR

Castor beans contain ricin.

Jequirity beans contain abrin.