itku2er Posted April 10, 2009 Author Share Posted April 10, 2009 Good question though Ruff If anyone has any other thoughts on that I would love to hear them. I just got information from different places by googling it. Link to comment Share on other sites More sharing options...
Doczilla Posted April 10, 2009 Share Posted April 10, 2009 Would you administer activated charcoal to this patient? Would it be helpful if you did? If this is a magnesium product she ingested, what sort of signs, symptoms, and EKG manifestations would you expect? How would you treat them? Besides the heavy metals, what is another major type of rat poison? 'zilla Link to comment Share on other sites More sharing options...
Just Plain Ruff Posted April 10, 2009 Share Posted April 10, 2009 (edited) Would you administer activated charcoal to this patient? Would it be helpful if you did? If this is a magnesium product she ingested, what sort of signs, symptoms, and EKG manifestations would you expect? How would you treat them? Besides the heavy metals, what is another major type of rat poison? 'zilla Zilla, if the rat poison is a superanticoagulant and the patient has not started to bleed much then by all means give charcoal but most of the time the time of ingestion is way off and the charcoal may not help at all. Plus, one study I read about showed that the difference between giving charcoal and fluids versus giving just charcoal was as follows 6/110 patients had a increased INR 24-48 hours post ingestion with fluids dilution alone where 1/110 patients had increased INR with charcoal and fluids. In my mind only 7/110 had any benefit to the fluids/charcoal or charcoal only treatment. So charcoal may help in 1% of the cases (extrapolated from this study) but 99% of the patients would not prove beneficial. Here's the link to the article I read http://www.mnpoison.org/index.asp?pageID=150 (scroll down to the Decontamination section) for the magnesium overdose - see this article on emedicine - http://emedicine.medscape.com/article/246489-overview Another form of Rat poison is similar to warfarin overdose. So you'd need some Vitamin K to start off - I'd start with 10mg but may go up to 25mg if severe bleeding is occurring but 99.999999 of all ambulance service carry vitamin K so the ER would be the place to get this treatment going. I'd draw some lab if I was able so they could check the INR of your sample. This might be one of the only times that a anal rententive lab director would allow EMS blood to be used. Once the K is started at 10-25mg SQ continue to monitor the INR and other clotting factors, admit to the ICU and watch the patient. One caveat to remember - giving Vitamin K as a standard treatment to a asymptomatic patient will negate any value to the INR for a specified period of time and we need to remember that Coagulopathies can develop over time and if you don't have a valid INR then you are WAY behind the 8 ball and the patient will suffer. So routine giving of Vitamin K for these overdoses without a initial INR would not be in the patients best interest. Edited April 10, 2009 by Ruffems Link to comment Share on other sites More sharing options...
FireMedic65 Posted April 10, 2009 Share Posted April 10, 2009 We no longer carry activated charcoal where I work. I know silly huh? Anyway, I would contact poison control and consult with them and notify the hospital of what they say or get a call back number to continue their suggestions. Link to comment Share on other sites More sharing options...
vetlemakt Posted April 10, 2009 Share Posted April 10, 2009 Well, this was an interesting scenario indeed. In my experience the patient would either tell us she'd tried to kill herself upon us making first contact, or else been hesitant and uncooperative, but for the sake of discussion and learning, this is a good way to present scenarios. And I like the detective bit of this scenario, haha! I would have considered provoking her to vomit if it wasn't for the 6 hour period since intake. In such a long time, I will expect the poison to have been fully consumed. Active coal isn't something we've got in our service anymore, I might have to ask for it again. Can't see why we shouldn't be carrying that. In any case, that would also have been useless in this scenario, I fear. Hurried transport, O2, NaCl. And get someone to take care of her husband when he arrives at the hospital, his missus might not have the best prognosis. Link to comment Share on other sites More sharing options...
Kaisu Posted April 10, 2009 Share Posted April 10, 2009 considerate of her to save him the time, hassle and expense of divorce..... Link to comment Share on other sites More sharing options...
brentoli Posted April 10, 2009 Share Posted April 10, 2009 considerate of her to save him the time, hassle and expense of divorce..... Which is also a common denominator in female suicides. Consideration. Link to comment Share on other sites More sharing options...
Jeepluv77 Posted April 10, 2009 Share Posted April 10, 2009 I'd ask her if she even wants him there or not. Either way, I'd notify hospital staff of the marital situation and ask them to monitor interactions. The last thing this woman needs right now is him marching in there to tell her how dumb she is, that he's glad, he's still leaving, etc. If he can't be totally supportive of her recovery, at least for now, then he needs to go somewhere else. I'm not saying that he is going to say any of those things, he very well could go in and be the most loving husband ever, but you never know. We don't know why he's leaving her. Given that he took her to Mexico 3 months ago and now he wants a divorce, something changed fairly recently enough that he no longer wants to try. Link to comment Share on other sites More sharing options...
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