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wikitox:supportive_care [2024/05/14 00:37] – kharriswikitox:supportive_care [2025/02/17 00:34] (current) – kharris
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- <font 36px/inherit;;#c12404;;inherit>Supportive Care</font>+====== Supportive Care ======
  
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 If a patient continues to show evidence of hypoperfusion despite adequate fluid loading then they will require inotropic or vasopressor support. The decision of which agent to use will depend on the known toxicity of the agent(s) taken but is also greatly aided by bedside echocardigram which can help differentiate between vasoplegia or reduced cardiac contractility being the predominant cause. If a patient continues to show evidence of hypoperfusion despite adequate fluid loading then they will require inotropic or vasopressor support. The decision of which agent to use will depend on the known toxicity of the agent(s) taken but is also greatly aided by bedside echocardigram which can help differentiate between vasoplegia or reduced cardiac contractility being the predominant cause.
- + <font inherit/inherit;;#b12c04;;inherit>**Adrenaline**</font>  , given as an infusion, is the most commonly used first-line inotrope and can partcularly useful if there is associated bradycardia. 
-  * + <font inherit/inherit;;#b12c04;;inherit>**High-dose Insulin Euglycaemic Therapy (HIET)**</font>  is used second-line for cadiotoxic ingestions (e.g. beta-blocker and non-dihydropyridine calcium channel blockers). 
- <font inherit/inherit;;#b12c04;;inherit>**Adrenaline**</font> , given as an infusion, is the most commonly used first-line inotrope and can partcularly useful if there is associated bradycardia. + <font inherit/inherit;;#b12c04;;inherit>**Noradrenaline**</font>  , again given by infusion, is the most commonly used first-line agent for vasoplegia with 
- <font inherit/inherit;;#b12c04;;inherit>**High-dose Insulin Euglycaemic Therapy (HIET)**</font> is used second-line for cadiotoxic ingestions (e.g. beta-blocker and non-dihydropyridine calcium channel blockers). + <font inherit/inherit;;#b12c04;;inherit>**vasopressin**</font>  being a common second option.
- +
-  * +
- <font inherit/inherit;;#b12c04;;inherit>**Noradrenaline**</font> , again given by infusion, is the most commonly used first-line agent for vasoplegia with +
- <font inherit/inherit;;#b12c04;;inherit>**vasopressin**</font> being a common second option.+
  
 Advice regarding the use of specific agents for sepcific ingestions can be found in the drug monographs. Advice regarding the use of specific agents for sepcific ingestions can be found in the drug monographs.
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 With renal clearance being an important factor in the elimination of many drugs from the body, the development of renal injury may increase the severity or duration of the experienced toxicity. Develoipment of dehyration may also lead to hypotension and increase the risk of thromboembolism. With renal clearance being an important factor in the elimination of many drugs from the body, the development of renal injury may increase the severity or duration of the experienced toxicity. Develoipment of dehyration may also lead to hypotension and increase the risk of thromboembolism.
- <font inherit/inherit;;#b12c04;;inherit>**Ensure adequate hydration is maintained in all toxicology patients**</font> , taking into account fluids losses and maintainance fluid requirements. Ensure that electrolytes are maintained at appropriate levels - especially important when considering specific toxicity (e.g. agents causing cardiac toxicity, [[:wikitox:2.1.11.9.4_mood_stabilizers|lithium]]). + <font inherit/inherit;;#b12c04;;inherit>**Ensure adequate hydration is maintained in all toxicology patients**</font>  , taking into account fluids losses and maintainance fluid requirements. Ensure that electrolytes are maintained at appropriate levels - especially important when considering specific toxicity (e.g. agents causing cardiac toxicity, [[:wikitox:2.1.11.9.4_mood_stabilizers|lithium]]). 
- <font inherit/inherit;;#b12c04;;inherit>**Provide antiemetics in those with nausea and vomiting**</font> to aid in maintainance of oral intake.+ <font inherit/inherit;;#b12c04;;inherit>**Provide antiemetics in those with nausea and vomiting**</font>  to aid in maintainance of oral intake.
  
 In patients with sedation or anticholinergic effects it is important to consider urinary retension and In patients with sedation or anticholinergic effects it is important to consider urinary retension and
- <font inherit/inherit;;#b12c04;;inherit>**conduct regular bladder scans**</font> in those not passing urine.+ <font inherit/inherit;;#b12c04;;inherit>**conduct regular bladder scans**</font>  in those not passing urine.
  
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 In patients who had deep or prolonged sedation, In patients who had deep or prolonged sedation,
- <font inherit/inherit;;#b12c04;;inherit>**consider providing thromboprophylaxis**</font> as per your local protocol (e.g. 40mg s/c clexance) in those that do not have a contraindication. Nursing cares should also include + <font inherit/inherit;;#b12c04;;inherit>**consider providing thromboprophylaxis**</font>  as per your local protocol (e.g. 40mg s/c clexance) in those that do not have a contraindication. Nursing cares should also include 
- <font inherit/inherit;;#b12c04;;inherit>**pressure releaving matresses and regular turns**</font> to minimise risk of pressure area development.+ <font inherit/inherit;;#b12c04;;inherit>**pressure releaving matresses and regular turns**</font>  to minimise risk of pressure area development.
  
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