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ToxCard: Chronic Organophosphate Toxicity

EMDocs

doi:10.1080/10773525.2015.1123848 Povey AC, Rees HG, Thompson JP, Watkins G, Stocks SJ, Karalliedde L. Two assays available used to help confirm diagnosis, however, do not guide treatment Low levels of activity are consistent with organophosphate poisoning. 3 However, may be helpful in diagnosing the chronic toxicity forms. 2016;22(1):68-79.

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ToxCard: Acute Organophosphate Toxicity

EMDocs

8 Plasma butyrylcholinesterase (“pseudocholinesterase”) activity Easier to assay and is more widely available Red cell acetylcholinesterase (“true cholinesterase”) activity More accurate and specific Management: Patients require immediate intervention if there is concern for acute organophosphate poisoning. Br J Clin Pharmacol.

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ToxCard: Organic Mercury Poisoning

EMDocs

7 We are commonly taught that metals are not amenable to treatment with activated charcoal (AC).However, In short, there is not a whole lot of evidence to support this, but if patient has had a recent ingestion and is not altered, you can consider gastrointestinal decontamination with AC. 2019 Jan 16;2019:4275918.

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Penetrating chest trauma

Don't Forget the Bubbles

This was a randomised controlled multisite study comparing resuscitation of trauma patients requiring massive transfusion using either 1:1::1 or 1:1:2 ratios of platelets to plasma to red blood cells. Pragmatic Randomized Optimal Platelet and Plasma Ratios (PROPPR) Trial: design, rationale and implementation. 2019 Aug;31(4):683-687.

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Sickle Cell Disease Module

Don't Forget the Bubbles

SCD, therefore, is not only a mechanical disease but there are also many other cellular and plasma factors as well as endothelial interaction that generate chronic inflammation. Opioids do not cause ACS but they can exacerbate hypoxia in patients with ACS. Morphine sulphate is the commonest strong opioid to start with.

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