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Flashcards in Poisoning Deck (15):
1

Common drugs ingested

Aspirin
Paracetamol
Antidepressants

2

Common household agents ingested

Disinfectants
Bleach
Weedkiller
Parrafin or white spirit
Dishwasher tablets

3

Assessment

Type of ingestion (drug, preparation)
Time of incident
Amount of ingestion (include all medication that was potentially in the bottle or packet when calculating)
Weight of child
Is the ingestion potentially harmful?
Beware of the possibility of mixed overdose
Beware of the possibility of inaccurate dose reporting on history taking
If mixed or undetermined ingestion Paracetamol level should be done.

4

Important examination

Conscious level
Pupils equal and reactive
Vitals
Evidence in mouth of ingestion

5

Management

Call poisons unit
Management

Airway
Breathing
Circulation
Disability, AVPU
Glucose
ECG
Removal of poison (if necessary)

Emesis
No role in the hospital setting
Activated Charcoal
Has a very limited role in treatment and should not be used without consultation with a toxicologist.

->Whole Bowel Irrigation has a limited role in treatment of some slow release preparations
->Gastric Lavage has a very limited role in treatment and should not be used without consultation.
->Specific antidotes may be available and serum drug levels may help in treatment decisions

Advice on home safety and avoiding additional poisonings

6

Contraindications to activated charcoal

Contraindications:
Patients with altered conscious state
The following agents:
Ethanol/glycols
Alkalis
Boric acid
Lithium
Iron compounds
Potassium and other metallic ions
Fluoride
Cyanide
Hydrocarbons
Mineral acids

7

Intentional poisoning in adolescent

Must be admitted until adolescent unit after discussion with mental health team

8

Assessment of coma/ALOC with posioning

Assess direct, secondary and non-toxicological reasons for ALOC

9

What can cause ALOC in poisoning

Direct toxic effect
Secondary effect mediated by hypoxia, hypoglycemia, hyponatremia, hypotension, seizures, edema
Non-toxicological->head injury

10

Investigations in ALOC and poisoning

ECG
Paracetamol levels
VBG, anion gap, osmolar gap
Drug levels
Specific Mx for->ethanol, phenobarbitone/carbamazepine/valproic acid, aspirin and toxic alcohols level in unexplained metabolic acidosis
Consider flumazenil to confirm benzodiazepine overdose, but not if possibility of coingestion of pro-anticonvulsant substances

11

Assessment of delirium and agitation from poisoning

Consider potential for harm to self/staff/community
Assess direct, secondary and non-toxicological complications

12

Management of delirium from poisoning

ABC
Glucose
Electrolytes
General manage infection, trauma etc
Specific:
1. Calm environment->Oriented, quite, reassured
2. Physical restraint until pharmacological restraint can be achieved
3. Oral / IV diazepam or IV/IM midazolam if oral not possible
4. Antipsychotics->caution Haloperidol with anticholinergic. Olanzepine can be given orally.
5. If hyperpyrexia urgent contact with Poisons->Poisons Info contact number (131126)

13

Seizures in the setting of these ingestions indicate worse prognosis

Salicylates
Theophyline
TCA's
Propranolol
Chloroquine
Isoniazid

14

What is pyridoxine specific treatment for

Seizures due to isoniazid toxicity

15

Management of hypotension with poisoning

ABC
IV access
Fluids
ECG- correct dysrrhythmias
VBG
Glucose
Seek senior help, ongoing monitoring, admit

For refractory shock->need ICU
Inotrope and vasopressor
Insulin-dextrose euglycemia for CCB overdose
ECMO for refractory severe cardiovascular compromise
Consideration of "lipid rescue" in cases of local anaesthetic toxicity (and other drugs) leading to cardiovascular collapse refractory to conventional therapy

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