POISONING AND ITS MANAGEMENT
A poison is any chemical that harms the body .
Poisoning represents the harmful effects on the human body of accidental or intentional exposure to toxic amounts of any substance.
COMMON CAUSE OF POISON
- Alcohol
- Trycyclic antidepressant
- NSAIDS
- Iron
- Toxic plants
- Acetaminophen
ROUTES OF POISONING
1.Ingestion
2.Inhalation
3.Injection
4. Absorption
CLINICAL MANIFESTATIONS
- Vomiting
- Diarrhoea
- Upper abdominal pain
- Jaundice
- Tounge discoloration
- Abdominal tenderness
- Changes in pupil size
DANGER SIGN :-
- No breathing
- Wheezy and noisy breathing
- Pulse below 50 or above 110b/m irregular or very weak
- Non reacting pupils
- Loss of consciousness
- Continuous seizures
- Severe abdominal tenderness
INVESTIGATION:-
- BUN and creatinine
- Electrolyte level
- Liver function test
- Toxicological analysis of identified substance or tissue samples eg.gastric aspirate
POISONING SEVERITY GRADES
None (0):- No symptoms or sign
Minor(1):- Mild,transient and spontaneously resolving symptoms
Moderate (2):- Pronounced and prolonged symptoms
Severe(3):- Severe and life threatening symptoms
MANAGEMENT
Emergency stabilization measures
1.The unconcious patients should be transported in the headdown semiprone position to minimize the risk of inhalation of gastric contents .
2. A clear airways established and ventilation is maintained.
3.Neurological assessment is made by calculating the Glasgow coma scale .
4.Maintain A,B,C
Symptomatic and supportive management
1.Hemodynamic support
- Elevation of foot end of the bed
- Oxygen administration
- IV fluids
- Blood products
2.Cardiac dysrhythmias
- Correction of hypoxia
- Acidosis
- Antiarrhythmic drugs
3.Convulsions
- Anticonvulsant therapy
4.Management of hypothermia
- Provide Blanket
- Maintain warm environment
5.Management of Pain
- Analgesics
REMOVAL OF TOXINS
The aim of decontamination procedure is to reduce the absorption of poison.
1. Eye decontamination :-
- This achived by copious irrigation with neutralizing solutions (Normal saline or water)for atleast 30min .Do not use acid or alkaline irrigating solution.
2.Dermal decontamination :-
- Absorption of organophosphorus and related compounds through cutaneous route can prove to be a fatal as oral route absorption.
- Remove all contaminated clothes and irrigate the whole body including nails ,groin,skinfolds with water and saline as soon as possible after exposure and continuous irrigating for atleast 15min.
- Water should not be used to decontaminate skin in exposure to sodium and phosphorus.
3.Gut decontamination :-
A. Gastric lavage :-
Gastric lavage is the administration and evacuation of small volume of liquid through an orogastric tube to remove toxic substances within the stomach .
B. Absorbent administration :-
- An agent capable of binding to a toxic agent in the GIT is known as absorbent. Its created by subjecting carbonaceous materials eg.wood coal etc.
- For comatose patients with potentially serious overdose gastric lavage is followed by administration of activated charcoal via an orogastric or nasogastric tube within 1 -2hrs of ingestion.
- Activated charcoal administered should be atleast 10 times the dose of ingested toxic materials.
- In asymptomatic patients presenting early or without reliable history 15-30 gm of charcoal may be used .
C. Catharsis/Cathartic :-
- A cathartic is the substance that is accelerate defecation
- Laxatives and purgatives may be given in poisoning with substance which do not cause corrosive action on gastrointestinal mucosa .
- It increased motility of the gut may reduce absorption. Eg.Sorbitol and mannitol
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