Lecture 2 - Patient Management and Decontamination

What is the first step if you think a patient has a toxicity?

Stabilize the patient (ABCs)

What should you do directly after stabilization?

Draw blood for laboratory profile (ideally 3cc EDTA and 2 serum tubes)

What questions should you ask when obtaining a history?

-Did anyone witness exposure? If so what was the substance and amount? How long ago?

-If no witness, when was the pt last normal? Other pets? Any initial signs that are no longer apparent?

-Location of the animal a few hours prior to development of signs

What should you do after obtaining a history?

Formulate rule out list

What is the purpose of decontamination?

Prevent absorption in an asymptomatic animal

What should you do with ocular exposures?

-Find out substance (Can cause anything from irritation to corrosion)

-Flush with tap water, normal saline, or artificial tears for 20-30 min

-Fluorescein staining to detect damage

What should you do if there is dermal decontamination?

-Remove compounds from the skin/fur to limit absorption

-Wash with liquid dish washing detergent

What should you do with avian’s if there is a light exposure? What about a heavy one?

-Light exposure: spray lightly with diluted milk liquid dish soap and warm water

-Heavy exposure: thorough bathing with liquid dish soap and warm water

How do you remove glue traps, asphalt, or pine sap?

-Oily substance (olive oil, mayonnaise, peanut butter, mineral oil, vegetable oil

-Rub a small amount into area then was with dish soap

What species should you not use mineral oil in?

Birds

What is the purpose of dilution? What substances are commonly used as dilutants?

-Make compounds less irritating

-Milk, water, milk of magnesia

What is the purpose of emesis?

-Remove substances from stomach

-Case by case decision (must weigh risks and benefits)

What are some contraindications with emesis?

-Do not induce after ingestion of a caustic substance

-Do not induce in animals that cannot vomit (ex. rodents, horses, ruminants, etc)

What can you use at home to make dogs vomit? How much can you give?

-3% hydrogen peroxide

-Can give 1mL to 45mL/lb

What other drugs can induce emesis in dogs?

-Apomorphine - acts on dopamine receptors

-Ropinerole (Clevor) - dopamine agonist eye drops

What type of drug can be used to induce vomiting in cats?

Alpha-2 agonists (xylazine, dexmedetomidine)

What are some other methods to remove toxic materials from the stomach?

-Endoscope

-Rumenotomy (life-threatening situations)

-Gastric lavage

-Crop lavage

What are contraindications with gastric lavage?

-Petroleum distillates

-Corrosives

How does activated charcoal work as an adsorbant?

Binds most organic compounds and facilitates excretion in feces

What are some contraindications of activated charcoal?

-Compromised airway (aspiration risk)

-Seizures/coma

-Caustic materials (doesn’t bind)
-Petroleum distillates

-Small chemical compounds (ethanol, methanol, fertilizer, iodides, nitrates, nitrites, etc) or heavy metals

-Endoscopy

How can activated charcoal cause hypernatremia?

Contains osmotically active ingredients that draw free water into the GI tract

What are signs of hypernatremia? What are treatment options?

-Signs: ataxia, tremors, seizures, death

-Low sodium fluids, warm water enema

What is a cathartic? What happens without one? When should you not use a cathartic?

-Decreases GI transit time

-Without it, toxicant bound by activated charcoal can be released and reabsorbed

-Dehydrated or has diarrhea

What are bulk cathartics?

-Used to help remove heavy items from GI tract

-High fiber so retain water and produce more bulky stools

What are osmotic cathartics? Which is most common?

-Pulls electrolytes and free water into GI tract

-Most common is sorbitol

What are saline cathartics? When should they be avoided?

-Stimulate GI motility (Na sulfate, Mg sulfate)

-Avoid with renal disease, ileus, or in birds/reptiles

What are examples of emollient laxatives? What are contraindications?

-Mineral oil and vaseline

-Contraindications: vomiting (aspiration)

What is ion trapping? How do you remove basic drugs? Acidic drugs?

-Ionized substances less able to pass through membranes

-Basic drugs: acidic urine (ammonium chloride)

-Acidic drugs: basic urine (sodium bicarbonate)

What is diuresis? When is it most effective?

-Twice maintenance rate of fluids or more

-Most effective if agent is excreted primarily by kidneys

When is peritoneal dialysis helpful?

Removal of small, water-soluble molecules in peritoneal cavity

What is hemodialysis/hemoperfusion?

Blood containing toxicant molecules filtered through machine binding free toxicant?

What is plasma exchange?

Plasma removed from blood and exchanged with fresh plasma

How do you treat inhaled toxicants?

-Remove source of inhalant

-Oxygen

-Fresh air

-Monitor for pulmonary edema