Environmental Injury: Toxins, Overdose, Drowning, Thermal Burns

Working knowledge of toxins and environmental injuries is important to the intensivist in any ICU. This chapter focuses on the initial management of the poisoned, drowned, and burned patient with emphasis on resuscitation and the essential points of care following stabilization. The section on toxins and overdose provides information on general resuscitation as well as key toxin-specific points, illustrates a pattern-recognition based framework for dealing with undifferentiated toxidromes, discusses important antidotes, and outlines enhanced elimination and detoxification modalities. The section on drowning discusses epidemiology, the pathophysiology of drowning, and highlights the need to investigate for and treat medical conditions and injuries that frequently occur along with drowning. Finally, the section on thermal burns delves into the special considerations needed for airway assessment and management of burn patients, inhalation injuries, fluid resuscitation, wound care, and indications for transfer to a dedicated burn center.