اوردر ها:

1️⃣ Admit to:
2️⃣ Impression: Acetaminophen overdose
3️⃣ Condition:
4️⃣ Vital Signs:
5️⃣ Activity:
6️⃣ Nursing: ECG monitoring, I/O, pulse oximeter, aspiration precautions.
7️⃣ Diet:

8️⃣ داروها :


Gastric lavage with 10 mL/kg (if >5 yrs, use 150-200 mL) of normal saline by nasogastric tube if < 60 minutes after ingestion.
Activated charcoal (if recent ingestion) 1 gm/kg PO/ NG q2-4h, remove via suction prior to acetylcysteine.
N-Acetylcysteine (Mucomyst, NAC) loading dose 140 mg/kg PO/ NG, then 70 mg/kg PO/NG q4h x 17 doses (20% sln diluted 1:4 in carbonated beverage); follow acetaminophen levels. Continue for full treatment course even if serum levels fall below nomogram.
Phytonadione (Vitamin K) 1-5 mg PO/IV/IM/SQ (if INR >1.5).
Fresh frozen plasma should be administered if INR >3.

9️⃣ سایر اقدامات پاراکلینیک :Portable CXR. Nephrology consult for charcoal hemoperfusion.

آزمایشات : CBC, SMA-7 (BUN/Cr, Electrolytes (Na, K, Cl, HCO3, ...), BS), liver panel, amylase, INR/PTT; SGOT, SGPT, bilirubin, acetaminophen level /Stat and q4h until nondetectable. Plot serum acetaminophen level on Rumack-Matthew nomogram to assess severity of ingestion unless sustained release Tylenol was ingested. Toxicity is likely with ingestion >150 mg/kg (or 7.5 gm in a