It was also the first hospital to have a maternity ward, the first to have an on-site medical school, the first to have an ambulance corps (originally driven by horses, their coaches outfitted with stretchers, whiskey, bandages, straitjackets and stomach pumps).
|
|
Many of the initial signs are those associated to the anticholinergic effects of TCAs such as dry mouth, blurred vision, urinary retention, constipation, dizziness, and emesis (or vomiting). Due to the location of norepinephrine receptors all over the body, many physical signs are also associated with a TCA overdose:California Poison Control 1-800-876-4766 # Anticholinergic effects: altered mental status (e.g., agitation, confusion, lethargy, etc.), resting sinus tachycardia, dry mouth, mydriasis (pupil dilation), fever # Cardiac effects: hypertension (early and transient, should not be treated), tachycardia, orthostasis and hypotension, arrhythmias (including ventricular tachycardia and ventricular fibrillation, most serious consequence) / ECG changes (prolonged QRS, QT, and PR intervals) # CNS effects: syncope, seizure, coma, myoclonus, hyperreflexia # Pulmonary effects: hypoventilation resulting from CNS depression # Gastrointestinal effects: decreased or absent bowel sounds Treatment of TCA overdose depends on severity of symptoms: Initially, gastric decontamination of the patient is achieved by administering, either orally or via a nasogastric tube, activated charcoal pre-mixed with water, which adsorbs the drug in the gastrointestinal tract (most useful if given within 2 hours of drug ingestion). Other decontamination methods such as stomach pumps, gastric lavage, whole bowel irrigation, or (ipecac induced) emesis, are not recommended in TCA poisoning.
|
|