General management of poisoning

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General management of poisoning

• What is Toxicology
• What is a poison
• poison is any product or substance that can harm
  someone if it is used
• in the wrong way .
• by the wrong person
• or in the wrong amount .

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Examples of possible poisons include,

• some household products
• chemicals at work or in the environment
• drugs (prescription, over-the-counter, herbal) .
• Snake bites, spider bites, and scorpion stings

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Classification of poison

• 1-According to their mode of action
• Poisons with local action
• Poisons with remote action
• Poisons with both local and remote actions
• 2-According to the organs affected hepatotoxic
  cardiotoxic- nephrotoxic
• 3-According to the chemical nature
• Acidic poison organic -etc

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Factors affecting the action of poisons

• Age of the person
• Personal hypersensitivity
• Tolerance
• Idiosyncrasy
• State of health

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Factors affecting the action of poisons

• Condition of the stomach
• Synergism
• State of the poison
• Methods of administration
• Dose of the poison

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Diagnosis of Poisoning

• 1- History and circumstantial evidences
• 2- Clinical picture (signs and symptoms)
• Contracted pupils in morphine, organophosphorous,
  
• Dilated pupils in atropine, cocaine,
• Red skin in carbon monoxide and cyanide
  poisoning.
• Flushed face in atropine and alcohol poisoning
• Patches around the mouth in corrosives.
• Characteristic smell of the mouth
• Fever in atropine, salicylate, antidepressants.
• Convulsions in oxalic acid, strychnine, ergot,
  insecticides

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3- Radiopacity of poisons

• There are a number of tablets with different
  chemical compositions that exhibit varying
  degrees of Radiopacity.
• Barium,
• Enteric coated tablets,
• Tricyclics antidepressants ,
• Antihistamines ,
• Heavy metals

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4- Chemical analysis

• The most important evidence of poisoning is by
  chemical analysis .
• ???A- In the living
• Samples are taken from vomit, gastric lavage,
  blood, urine and stool.
• B- In the dead
• Blood from the heart or femoral vein.
• Stomach and its contents and parts of the
  intestines
• Parts of the liver, kidney, brain, lung

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Screening tests

• These are various tests to evaluate the type (and
  roughly measure the amount) of legal and illegal
  drugs a person has taken.

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General treatment of poisoning

• There are eight essentials of overdose management
  that may be considered for the patients with
  poisoning. All or some of them may be used for
  the patient according to his clinical state.
• Decontamination
• Supportive care.
• Prevent further exposure to the poison.
• Removal of the unabsorbed poison from the
  stomach.
• Inactivation of the poison remaining in the
  stomach.
• Enhancement of excretion.
• Administration of an antidote.
• Symptomatic treatment.

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1-DECONTAMINATION

• Skin
• Wear protective clothes gloves
• Remove the patients contaminated clothing
• Flush exposed areas with copious quantities of
  water

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Eyes

• Corrosive agents
• Toxins that are readily eye absorbed
• Flush exposed eyes with copious quantities of
  water or saline
• check the pH of the tears
• Do not instill any neutralizing solution

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Inhalation

• Irritating gases and fumes e.g. chlorine gas.
• Toxin that are absorbed through the respiratory
  tract
• Remove the victim from exposure
• Observe for evidence of upper respiratory edema
• Administer humidified 02

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2-Supportive care

• A large group of acutely poisoned patients can be
  treated with supportive care. The drug will be
  progressively eliminated over the next 12 to 36
  hours in most patients, and usually this is all
  the care that is necessary.

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3-Prevent further exposure to the poisons

• Suicidal cases must be hospitalized
• In industrial or agricultural exposure
• In cases of toxic inhalants

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4-Removal of the unabsorbed poison

• 1- Emesis
• (chemical mechanical )
• Contraindication
• 2- Gastric lavage
• Contraindication of gastric lavage

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5- Inactivation of poison remaining in the
stomach

• 1-Physical antidotes
• (demulcents Diluents Adsorbing )
• 2-Chemical antidotes
• A- precipitating antidotes
• B- Oxidizing antidotes
• C-Reducing antidotes

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Household antidotes

• Substances that are available
• in a house and can be used as
• a first aid treatment of poisoning
• What do u think ?

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6-Enhancement of excretion

• Poisons eliminated through the lung
• (in expired air)
• Poisons excreted through intestine (in stool)
• (purgatives )
• Poisons excreted through bile e.g. morphine
• (Multiple-dose activated charcoal (

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Poisons excreted by the kidney (in urine)

• Fluid diuresis
• Forced diuresis
• Forced osmotic dieresis
• Forced acid diuresis
• Forced alkaline diuresis
• 3. Hemodialysis (artificial kidney)
• 4. Peritoneal dialysis

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7- Administration of physiological antidote if
available

• Diazepam in strychnine poisoning.
• Atropine in organophosphorous (antagonize
  muscarinic action).
• Pilocarpine - peripheral action of atropine
• BAL (British antilewisite) in arsenic.
• EDTA (Ethylene Diamine Tetra-Acetate )
• Naloxone in morphine poisoning

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8- Symptomatic treatment.

• 1- coma
• Definition
• Grades
• Treatment

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2- Shock

• Definition
• BP
• Treatment

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3- Respiratory failure

• Definition
• Diagnosis (Blood Gases )
• Treatment

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4- Acid base disturbances

• Definition
• Diagnosis (Blood Gases - PH )
• Treatment

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5- Convulsion

• Definition
• Differential Diagnosis
• Treatment

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6- Disturbances in body temp

• Hypothermia
• Rectal temperature is below 36?C, treat the
  patient in warm room wrapping with blankets
• Hyperthermia
• Keep the patient in a cool, well ventilated room,
  ice bag, antipyretics and antibiotics may be
  needed.

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