Emergency Managment If Poisoning

Question 1

Stabilizing the patient

Answer 1

Airways —>intubate
Breathing —> ventilate
Circulation —> PRN
Disability —> reflexes

Question 2

Respiratory failure or depression

Answer 2

A patent airway
Cuffed endotracheal tube
Mechanical ventilation or oxygen (apnea, anoxia, severe anemia)

Question 3

How do you treat respiratory failure?

Answer 3

Doxapram- respiratory stimulant
Naloxone- If opiate induced

Question 4

Seizures

Answer 4

Comes with hypoxia, hyperthermia and acidosis
Use diazepam, phenobarbital and pentobarbital

Question 5

Diazapam

Answer 5

Drug of choice for acute seizures (prototype drug)
Usually re-administered every 10-20 minutes

Question 6

Phenobarbital

Answer 6

Use if diazapm is ineffective
Can cause respiratory depression with excessive prolonged use

Question 7

Pentobarbital

Answer 7

Use to induce light anesthesia for refractory seizures
Excessive or prolonged use may cause CNS depression

Question 8

CNS depression

Answer 8

Opiate pain meds: tramadol

Question 9

Nalaxon (Narcan)

Answer 9

Useful for opiate induced respiratory depression
Reduces opioid overdoses (antagonist)

Question 10

Shock

Answer 10

Toxicants: cause fluid loss, vomiting, diarrhea, blood loss and cardiomyopathy
Monitor using Hb, PCV, and oxygen saturation

Question 11

Treating shock

Answer 11

Lactated rings solution, plasma expanders and whole blood

Question 12

Hyperthermia

Answer 12

Cold baths, ice packs and cooled IV fluids
Rehydrated with fluid therapy

Question 13

Hypothermia

Answer 13

Blankets, warm water bottles and heating pads
Warming the animals surroundings

Question 14

Prolonged vomiting or diarrhea possible etiologies

Answer 14

Toxicants: Organophosphate toxicosis
CNS causes or local irritation

Question 15

Treatment for prolonged vomiting or diarrhea possible etiologies

Answer 15

Atropine
GI hyperactivity
Helps to eliminate ingested toixcants →dehydration, acid base disturbances and electrolyte loss

Question 16

Histamine-type 2 receptor blockers

Answer 16

Cimetidine in dogs orally –> clinical improvement of simple gastritis

Question 17

Emesis

Answer 17

Removing poisons from the stomach (vomit)
Most effective first 2 hours post ingestion
Least effective if > 4 hrs

Question 18

How do you achieve emesis?

Answer 18

Physically (avoid)
Ipecac (humans), hydrogen peroxide
Pharmaceuticals (apomophine, xylazine and ropinirole/ clevor)

Question 19

Ipecac

Answer 19

Used orally in dogs and cats
Bitter taste and potential toxicity
Excessive vomiting, CNS depression

Question 20

Hydrogen peroxide

Answer 20

3% concentration
@ 1 tsp/10 lb bwt and wait 15-20 minutes
May repeat dose if needed, use after meal

Question 21

Ropinirole (clevor) in dogs

Answer 21

Eye drops (FDA approve fro dogs)
Stimulates D2 receptores in CRTZ

Question 22

Contraindications for emesis

Answer 22

Unconscious, depressed animals
Seizures or spontaneous seizures
Exposed to corrosive or caustic chemicals
Volatile materials (gas, petroleum, hydrocarbons)

Question 23

Which animals shouldn’t emesis be practiced on?

Answer 23

Rats, horse, rabbits and ruminants

Question 24

Catharsis

Answer 24

Enhancing elimination (defecation)
Sorbitol (most rapid/ potent)
Lactulose, Magnesium SO4, epsom salts, castor oil

Question 25

Gastric Lavage

Answer 25

Alternative of decontamination GIT Used when emesis ineffective/ contraindicated and unconscious/ anesthetized patient Used along with endotracheal tube to prevent aspiration of stomach contents

Question 26

Activated charcoal (AC)

Answer 26

Adsorbent Given following gastric lavage and when emesis is contraindicated Dosage: 2-5 g/kg in water slurry

Question 27

Gastrotomy/ rumenotomy

Answer 27

Used refractory to emesis, lavage or activated charcoal Indications: foreigns bodies, abnormal rads

Question 28

Persistent materials in the GIT

Answer 28

Toxic oils, tars, agents that reduce rumen motility

Question 29

Forced diuretics

Answer 29

Rapid renal filtration Furosemide and mannitol (cerebral edema)

Question 30

Caution with use of diuretics

Answer 30

Excessive fluid administration comes with cerebral edema, pulmonary edema and disturbance of acid-base or electrolyte status

Question 31

Ion trapping

Answer 31

To enhance elimination: Acidic drugs (aspirin), basic drugs (amphetamines), agents use to change pH

Question 32

Acid urine is promoted by ____________

Answer 32

Ammonium chloride

Question 33

Alkaline urine is promoted by _________

Answer 33

Sodium bicarbonate

Question 34

When is peritoneal dialysis used?

Answer 34

Useful failure and anuria cases

Question 35

Ocular exposure to toxins (decontamination)

Answer 35

Immediate flushing with water Repeated many times (20-30 minutes)

Question 36

Dermal exposure of toxins

Answer 36

Bathe --> warm water and soap, mild detergent, repeat prn Clipping to remove toxic residues from long haired animals