![]() Once in the back, a rapid primary survey shows a well-kept, well-dressed child without any obvious trauma. ![]() Your partner sees your new determined pace and asks if he can do anything to help you. You pull the girl closer and tell the family, “We’re going to the hospital now, if one of you wants to ride with, get in the front with my partner.” Poison control centers across the country fielded over 440,000 calls in 2013 related to children accidentally taking medications not meant for them. As an EMS provider, you need to know enough to suspect a significant poisoning and the first steps to take, whether the child is symptomatic yet or not. Others can have delayed effects, lulling parents and providers into a false sense of security until it’s too late. Some of these poisonings can mimic more common, less severe conditions. However, certain adult medications can cause death or severe illness when ingested by a young child. The good news is that most of these exposures aren’t life-threatening, and many are managed over the phone by poison control centers without the need for a hospital visit or 9-1-1 call. Most of these children are getting into medications in their own home that parents or other family members haven’t secured. 1 Children at these ages are becoming more mobile and exploring–and getting into things, including medications. Of these calls, 53% were for children between 1 and 2 years old. As you gather your patient into your arms, she’s more lifeless than any child you’ve held before, limp and barely breathing. You reach the patient, a 4-year-old girl lying on top of a city trash collection bin, still being shaken by Grandma. Through the maze of vehicles in the driveway, you see Grandma violently shaking and slapping your patient, repeatedly yelling, “Stay awake baby girl!” Your call has just escalated. “She’s in the garage with her grandmother. He meets you at your rescue door after you park in the driveway. As you drive into the narrowed streets with cookie-cutter houses, you see an older man waving to flag you down. The address is in a clean, middle-class neighborhood that isn’t known for problems with violence or illicit drugs, so you turn down the dispatcher’s offer of a simultaneous law enforcement dispatch. Thankfully, it’s coded as an omega overdose. The muffled overhead speech of your dispatcher is barely audible as you start moving toward your rescue, but you do hear that a child has taken something but isn’t initially symptomatic. Glucagon activates adenylyl cyclase through a DIFFERENT mechanism thereby restoring cAMP synthesis despite the presence of beta-blockers.You and your partner are sitting in the station when the familiar sound of the rescue tones goes off. Beta-blockers (especially selective beta-1 blockers) inhibit the Gs second messenger system normally involved with activating adenylyl cyclase to catalyze the formation of cyclic AMP (cAMP). I worry about two things in beta-blocker toxicity: hypoglycemia (which is obviously helped with glucagon) and the heart – namely decreased chronotropy (heart rate), inotropy (contractility), bradyarrhythmias, and hypotension from a combination of the aforementioned. But how is an anti-insulin hormone useful in treating this toxicity? In the ICU, I use a higher dose of glucagon (5-10 mg + drip titrated to effect) to reverse life-threatening hypoglycemia (with an amp or two of D50W) and to treat beta-blocker toxicity. Interestingly, glucagon has also been shown to relax smooth muscle in the airway via a nitric oxide/prostaglandin-mediated mechanism. ![]() In the OR, I most commonly administer 1 mg IV glucagon to relax gastrointestinal smooth muscle in cases like esophagectomies where esophago-gastric manipulation is critical. Glucagon (GlucaGen) is a secretin-type peptide hormone made in the pancreas responsible for catabolism primarily to produce glucose via glycogenolysis and gluconeogenesis in this sense, it’s an “anti-insulin” used in the treatment of profound hypoglycemia. ![]()
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