Host: The Japanese Society of Toxicology
Name : The 50th Annual Meeting of the Japanese Society of Toxicology
Date : June 19, 2023 - June 21, 2023
Acutely intoxicated patients can suddenly show abnormal changes with ABCDE (Airway/Breathing/Circulation/Dysfunction of CNS/Body temperature) until they are out of toxicity range. Unfortunately, some symptoms, such as lethal arrhythmias, lead to fatal outcomes. Therefore, rigorous patient monitoring is needed. This presentation will introduce the standard or expected monitoring devices to promote awareness of what to look for when using them.
The Airway/Breathing monitoring is performed to evaluate the airway patency and the appropriate ventilation status, but there are inaccuracies to be aware of. Percutaneous arterial oxygen saturation (SpO2) is inaccurate under specific conditions, such as low perfusion and abnormal hemoglobin existence. Non-invasive pulse CO oximetry can measure abnormal hemoglobin, but it doesn't have enough accuracy to diagnose.
While there are many circulatory monitoring devices, Electrocardiogram (ECG) is one of the most helpful devices for detecting QT elongation and arrhythmia. Recently, the ideas of "QT nomogram" and "ECG toxidrome" have been proposed to improve the QTc calculation and support the diagnosis.
The purpose of neuromonitoring is 1) to evaluate sedation and 2) to monitor the degree of brain injury and function. In particular, when treating poisonings that can cause seizures, continuous electroencephalography monitoring should be performed to detect Nonconvulsive Status Epilepticus in case of prolonged disturbance of consciousness.
Lastly, poor body temperature control is associated with poor outcomes. Therefore, core temperature monitoring is the most recommended and accurately measured by intravascular, esophageal, or bladder thermistors.
Proper monitoring should be chosen as each monitoring device may not be accurate depending on the types of substances or the patient's condition.
