management of poisoning

Question 1

What are the general principles n Poisoning management?

Answer 1

► Poison Stabilization and Evaluation
► Decontamination
► Poison elimination [ antidote Administration]
► Nursing care
► Psychiatric care

Question 2

this examination should be done on all patients to find out immediate abnormal measures which need to be stabilized starting with vital signs, conscious level and pupil size, skin temperature, pulse oximetry, and electrocardiogram.

Answer 2

Initial investigation or Initial screening

Question 3

ABCD of RESCUCITATION

Answer 3

A:Airway
B:Breathing
C:Circulation
D:Depression

Question 4

It is very important and can be obtained from the patients if they are alert and conscious.

Answer 4

History of the present illness

Question 5

If the patients are comatose or cannot give their history, in such situations, history can be taken from collateral information from family, friends, ambulance crew, or medical records looking for past psychiatry illness, previous history of suicide or drug abuse, chronic medication, etc.

Question 6

History must include time, route of entry, quantity, intentional or accidental exposure, availability of drugs at home, and if any member of the family has chronic diseases (hypertension, diabetic, etc.) and missing tablets or any empty pill bottles or other material was found around him.

Question 7

It may give clues regarding the substance which has been abused and toxidromes.

Answer 7

Physical examination of poisoned patients

Question 8

It occurs in the case of overdose of anticholinergic agents, antihistamines, TCAs, atropine, scopolamine, and phenothiazines.

Answer 8

Red and flushed skin

Question 9

It occurs in the case of sympathomimetics (cocaine), cholinergic agents (organophosphates), central hallucinogens (lysergic acid diethylamide (LSD) and phencyclidine) and salicylate toxicities

Answer 9

Pale and diaphoretic skin

Question 10

Central nervous system Depression may be caused by the following:

Answer 10

Anticholinergics
Antidepressants
Antipsychotics
Lithium
Cholinergic beta blockers
Clonidine
Sedative-hypnotics.

Question 11

Central nervous system Agitation [nervous excitement]

Answer 11

Sympathomimetics
Anticholinergics
Salicylates
Central hallucinogens
Drug withdrawal states
Carbon monoxide
Hypoglycemic agents
Heavy metals

Question 12

Common drugs causing miosis

Answer 12

∙ Opioids (morphine, hydromorphone, and oxycodone)
∙ Sedative-hypnotics (barbiturates and benzodiazepines)
∙ Cholinergic (nerve agents and organophosphate insecticides)
∙ Sympatholytic (clonidine and oxymetazoline)

Question 13

Common drugs causing mydriasis

Answer 13

∙ Sympathomimetics (cocaine and caffeine)
∙ Anticholinergics (atropine, scopolamine, and TCAs)
∙ Hallucinogens (LSD, mescaline, and psilocybin)
∙ Serotonin syndrome

Question 14

Common drugs causing nystagmus

Answer 14

Barbiturates
Carbamazepine
Phencyclidine
Phenytoin
Lithium

Question 15

It is a procedure where a dialysis machine and a special filter called an artificial kidney, or a dialyzer, are used to clean your blood.

Answer 15

Hemodialysis

Question 16

It is an extracorporeal blood purification modality that consists of the passage of anticoagulated whole blood through a device, usually a column, that contains adsorbent particles

Answer 16

Hemoperfusion

Question 17

The kidney can rapidly eliminate many water-soluble xenobiotics (exogenous chemicals). However, in the face of extraordinary serum concentrations of these xenobiotics or renal dysfunction, alternative elimination techniques often become necessary.

Question 18

These techniques are used to increase the clearance of xenobiotics.

Answer 18

Extracorporeal removal (ECR)

Question 19

Extracorporeal removal (ECR) techniques include

Answer 19

Hemodialysis (HD)
Charcoal hemoperfusion (HP),

and modalities grouped under the heading of continuous renal replacement therapy (CRRT): Continuous venovenous hemofiltration (CVVH)

Continuous venovenous hemodiafiltration (CVVHDF).

Question 20

It is induced by administering a fluid overload and adiureticconcurrently.

Answer 20

forced diuresis

Question 21

The primary problems associated with forced diuresis include potential fluid overload and electrolyte abnormalities. The practitioner should monitor for:

Answer 21

hyponatremia
hypokalemia
water intoxication
pulmonary edema
cerebral edema

Question 22

Additionally, some toxins such as ____ increase the patient’s susceptibility to interstitial pulmonary edema. Forced diuresis is contraindicated in these intoxications.

Answer 22

tricyclic antidepressants and many sedative-hypnotics

Question 24

The most common diuretics employed are:

Answer 24

furosemide (5 mg/kg every 6 to 8 hours) mannitol (1 to 2 g/kg IV every 6 hours).

Question 25

Uses PEG [ Golytely, Colyte] -Dosage:1-2hours [PO or by NGT Indications: -For poorly absorbed sustance

Answer 25

Whole Bowel Irrigation

Question 26

binds Cu, Pd, Hg -hydrolysis product of penicillin -P.O

Answer 26

Penicillamine [Cuprimine]

Question 27

-binds iron [Fe] -IV, IM, SC

Answer 27

Deferoxamine/Deferoxime [Desferal]

Question 28

-binds Pb, Mn, Zn -I,V [D5W or NSS] : I.M [Procaine HCl]

Answer 28

Calcium Disodium Edetate [Ca Na2EDTA or Ethylene diamine tetra acetic acid

Question 29

- I.M - Binds As, Hg, Pb, Sb, Au - serves as the metal acceptor and prevents binding of the SH groups of enzymes to metals. C.I in Fe, Cd,Se

Answer 29

Dimercaprol or BAL [British Antilewisite],

Question 30

contain electron-donating groups that react with metals to form complexes.

Answer 30

Chelating agents

Question 31

“universal Antidote”

Answer 31

Activated charcoal

Question 32

Not absorbed by Activated charcoal

Answer 32

Cyanide Iron Ethanol Lead Ethylene glycol Lithium Mercury Methanol Organic solvents Potassium Strong acid Strong alkalis

Question 33

It is a substance, usually a powder, taken to adsorb gases, toxins, and bacteria in the stomach and intestines. Examples include activated charcoal and kaolin.

Answer 33

Adsorbents

Question 34

- Alter the poison by forming an insoluble substance

Answer 34

Precipitants

Question 35

-Induce evacuation of bowel like Magnesium salts, Sugar alcohol [sorbitol], senna

Answer 35

Cathartics

Question 36

Syrup of Ipecac Age and Dose

Answer 36

6-9 months - 5 ml 9-12 months - 10 ml 1-12 years - 15 ml > 12 years - 30 ml

Question 37

Used for patients who are seen early following massive ingestions. - Patients who are unconscious or with diminished gag reflex.

Answer 37

Gastric Lavage

Question 38

- Prevents the absorption of the poison

Answer 38

Mechanical antidotes

Question 39

Change the chemical nature of poison Ex: sodium thiosulfate which converts cyanide into non-toxic SCN.

Answer 39

Chemical Antidote

Question 40

one that produced an opposite effects as that of the poison. Ex: [Caffeine-Ethanol or diazepam],[Atropine- Physostigmine],[INH- Pyridoxine]

Answer 40

Physiological Antidote

Question 41

General Antidotes

Answer 41

Physiological Antidote Chemical Antidote Mechanical Antidote

Question 42

Dermal Exposure

Answer 42

Remove the contaminated materials from patient Slightly cool water

Question 43

Ocular Exposure

Answer 43

NSS irrigation for 15 minutes

Question 44

Inhalation Exposure [One of the most dangerous]

Answer 44

Treatment: Rapid removal from environment If needed: 100% oxygen, assisted ventilation, bronchodilators