booone0 Posted July 24, 2010 Share Posted July 24, 2010 What common house-hold item is an antidote for ethylene glycol poisoning? How does it work? What is now used in most hospitals instead? Not a PA-S yet but I love this thread. :) Ok, going from memory here, I can answer half: Ethylene glycol and alcohol are both metabolized by Alcohol Dehydrogenase, with ETOH having a higher affinity for the enzyme. So, either IV or oral ETOH are given to prevent metabolism of the ethylene glycol. This is useful because the metabolites cause renal failure. I believe dialysis is also indicated. I know someone else will come with a more complete answer, so I'm off to wikipedia to satisfy my immediate curiosity. :D Quote Link to comment Share on other sites More sharing options...
deborah212 Posted July 25, 2010 Share Posted July 25, 2010 ETOH- not sure how it works or hosp alternative Ethylene glycol and alcohol are both metabolized by Alcohol Dehydrogenase, with ETOH having a higher affinity for the enzyme. So, either IV or oral ETOH are given to prevent metabolism of the ethylene glycol. This is useful because the metabolites cause renal failure. I believe dialysis is also indicated. Very good. Fomepizole is the drug used in the hospital setting with the same mechanism of action as EtOH. And you're right... ethylene glycol poisoning is an indication for dialysis (remember your AEIOUs). Quote Link to comment Share on other sites More sharing options...
deborah212 Posted July 25, 2010 Share Posted July 25, 2010 How does one treat acute pulmonary edema? (There are multiple right answers...) Quote Link to comment Share on other sites More sharing options...
EMSArtist Posted July 25, 2010 Share Posted July 25, 2010 How does one treat acute pulmonary edema? (There are multiple right answers...) Positive pressure ventilation Diuretics Q: Possibly dialysis ->IF not corrected w/ diuretics as an extension of Fluid Overload unresponsive to diuretics being an indication for dialysis? (disclaimer- not even close to PA-S yet... but I'm getting there) Quote Link to comment Share on other sites More sharing options...
Boggie911 Posted July 25, 2010 Share Posted July 25, 2010 What common house-hold item is an antidote for ethylene glycol poisoning? How does it work? What is now used in most hospitals instead? I believe the EtOH binds with stronger affinity to alcohol dehydrogenase, a major enzyme which catalyzes Ethylene Glycol to a more toxic agent (Formic acid?) My guess is fomepizole (4-MP) that's used in its place now. I think this treatment is similar to Methanol poisoning as well. Quote Link to comment Share on other sites More sharing options...
MikeyBoy Posted July 26, 2010 Share Posted July 26, 2010 What common house-hold item is an antidote for ethylene glycol poisoning? How does it work? What is now used in most hospitals instead? Figured I'd tack this on to the other answers. If I'm not mistaken, if you have the patients urine and suspect ethylene glycol, use a woods lamp and you may just see green urine for a (+) result. Quote Link to comment Share on other sites More sharing options...
andersenpa Posted July 26, 2010 Share Posted July 26, 2010 What are Hounsfield Units? Quote Link to comment Share on other sites More sharing options...
marilynpac Posted July 27, 2010 Share Posted July 27, 2010 a quantitative scale for describing radiodensity....wiki.. Quote Link to comment Share on other sites More sharing options...
andersenpa Posted July 28, 2010 Share Posted July 28, 2010 a quantitative scale for describing radiodensity....wiki.. Cheater- there is no wiki/googling on rounds...... Quote Link to comment Share on other sites More sharing options...
marilynpac Posted July 28, 2010 Share Posted July 28, 2010 Oh so sorry, I thought YOU didn't know...so sorry.... Quote Link to comment Share on other sites More sharing options...
andersenpa Posted July 28, 2010 Share Posted July 28, 2010 Oh so sorry, I thought YOU didn't know...so sorry.... young padawan, much to learn you have...... Quote Link to comment Share on other sites More sharing options...
deborah212 Posted July 28, 2010 Share Posted July 28, 2010 How does one treat acute pulmonary edema? (There are multiple right answers...) Positive pressure ventilation... Diuretics This was taught to be by the chief resident during my anesthesiology rotation, my last rotation in PA school. Strangely, I hadn't heard it before, so maybe it'll be new to some you as well. Lasix Morphine O2 Position (head of bead at 90 degrees) and Pressure (positive pressure ventilation) Now all of these are not usually used at once but it's a good mnemonic nonetheless. I usually start with O2 and IV lasix. If they don't respond after these interventions, the pt is probably headed to the ICU. Possibly dialysis It'd be unusual for pulmonary edema alone to be indication for dialysis unless the pt was also total body overloaded and anuric/oligouric (think renal patients). If a pt can produced urine, then pharmacological therapy is usually effective... but good thinking. Quote Link to comment Share on other sites More sharing options...
andersenpa Posted July 28, 2010 Share Posted July 28, 2010 Similar to the old CHF mnemonic LMNOP- N for nitrates. Nitrates are venodilators so if your cause of pulm edema is cardiogenic, preload reduction would help. Quote Link to comment Share on other sites More sharing options...
deborah212 Posted July 28, 2010 Share Posted July 28, 2010 Similar to the old CHF mnemonic LMNOP- N for nitrates. Nitrates are venodilators so if your cause of pulm edema is cardiogenic, preload reduction would help. Oops. You're right- was in a rush this morning and forgot the N for nitrates. Thanks, Anderson. So... Lasix Morphine Nitrates Oxygen Position/Pressure Quote Link to comment Share on other sites More sharing options...
EMSArtist Posted July 29, 2010 Share Posted July 29, 2010 Lasix Morphine Nitrates Oxygen Position/Pressure Ok... makes more sense now... Quote Link to comment Share on other sites More sharing options...
Evan Posted July 29, 2010 Share Posted July 29, 2010 Back in the old days they used nebulized alcohol (Vodka) for pulmonary edema... Dump a shot in the SVN, start 'er up at 8 LPM and away you go! Quote Link to comment Share on other sites More sharing options...
deborah212 Posted July 29, 2010 Share Posted July 29, 2010 Back in the old days they used nebulized alcohol (Vodka) for pulmonary edema... Dump a shot in the SVN, start 'er up at 8 LPM and away you go! Had to google that... Pretty nifty. Alcohol and Airways Function in Health and Disease Quote Link to comment Share on other sites More sharing options...
Evan Posted July 29, 2010 Share Posted July 29, 2010 There was even some banter at one point about nebulizing morphine for pulm edema... It conjured up images of that scene in Romancing the Stone when they build the fire in airplane: "now that's a fire..." Now that's an SVN tx!!! Quote Link to comment Share on other sites More sharing options...
marilynpac Posted July 29, 2010 Share Posted July 29, 2010 Other people here google, but boy I got spanked for it..... Quote Link to comment Share on other sites More sharing options...
EMSArtist Posted August 2, 2010 Share Posted August 2, 2010 Other people here google, but boy I got spanked for it..... Um... I'm gonna go out on a limb... no spankings for googling further information... just for looking up answers... Quote Link to comment Share on other sites More sharing options...
andersenpa Posted August 3, 2010 Share Posted August 3, 2010 What is the difference between cardioversion and defibrillation? Quote Link to comment Share on other sites More sharing options...
MCHAD Posted August 3, 2010 Share Posted August 3, 2010 I know that Defib is only for Pulseless V-tach and V-Fib, and you defib at 200 biphasic or 360 monophasic...Cardioversion is used for other abnormal rhythms (darn i don't remember which) but you start lower, 50 i believe and you have to have the defibrillator in Sync Mode. Also you cannot defib in sync mode... Quote Link to comment Share on other sites More sharing options...
Madison1979 Posted August 3, 2010 Share Posted August 3, 2010 Defibrillation is for nonperfusing ventricular rhythms (like MCHAD said, pulsless VTach and VFib) while cardioversion is for nonperfusing rhythms from above the ventricles, such as SVT or re-entry tachycardia. Both have the same goal of re-establishing a perfusing rhythm. Quote Link to comment Share on other sites More sharing options...
Administrator rev ronin Posted August 4, 2010 Administrator Share Posted August 4, 2010 Defibrillation is always electric, cardioversion can be pharmacologic (Adenosine). Quote Link to comment Share on other sites More sharing options...
andersenpa Posted August 4, 2010 Share Posted August 4, 2010 Everyone is getting at the right idea.... "Cardioversion" can be both chemical and electrical. In common use it refers to electrical conversion. Both use current delivery to uniformly depolarize the myocardium and reset circuits/reentrance/etc. Cardioversion is timed to the R wave (synchronized) so that the current is not delivered on the T wave, the dreaded R-on-T phenomenon which can lead to VF. (This can happen spontaneosly from a native PVC/ectopic signal at the right time). Cardioversion is used for organized ventricular rhythms- a fib, flutter, SVTs, etc. Cardioversion is technically used for VT since the ventricular activity is organized, just fast (+/- stability). Defibrillation is delivered at ANY time during the electrical cycle, and applies to only disorganized or pulseless rhythms (VF, pulseless VT). Defibrillation is by definition not synced. Quote Link to comment Share on other sites More sharing options...
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