Acute poisoning emergencies. Resolving the gastric decontamination controversy.

As in all medical emergencies, in acute poisoning the cornerstone of management is good supportive care. Aggressive support of the cardiovascular, respiratory, and central nervous systems, along with appropriate gastric decontamination, greatly reduces morbidity and mortality and improves patient outcome. Ipecac is generally reserved for home use, where it can be given to induce emesis immediately after ingestion of toxins, and it is given only in cases of mild or moderate toxicity. Activated charcoal should replace ipecac in the emergency department for cases of mild or moderate toxicity. Gastric lavage and administration of activated charcoal should be considered in cases with life-threatening potential. A cathartic should be considered after activated charcoal has been administered, but only in cases where it will not have a detrimental effect.

Pulmonary embolism.

Pulmonary thromboembolism is perhaps one of the most challenging diseases to recognize, diagnose, and treat appropriately in medicine today. Although the clinician is offered a variety of diagnostic modalities, a highly sensitive and specific diagnostic modality without significant risk does not yet exist. The newer noninvasive tests may offer valuable alternatives to the more invasive venogram and pulmonary angiogram. Figure 1 offers an algorithm for the diagnosis and management of thromboembolic disease. Failure to diagnose this entity can result in significant patient morbidity and mortality. Physicians must maintain a high index of suspicion as well as have an organized approach to diagnosis and management to improve survival of patients with thromboembolic disease.