3 - General Management of Poisoned Patients

a. NSS

1. which of the ff is useful in ocular decontamination

   a. NSS

   b. Diluted acetic acid

   c. Diluted weak base

   d. Carbonated drink

d. Mineral Oil

2. The following are present in universal antidote, except

   a. Tannic acid

   b. Magnesium Oxide

   c. Activated Carbon

   d. Mineral Oil

d. Na Thiocyanate

3. Which of the following is not a chelating agent?

   a. BAL

   b. EDTA

   C. Succimer

   d. Na Thiocyanate

a. Deferoxamine mesylate

4. The antidote for Iron poisoning

   a. Deferoxamine mesylate

   b. BAL in oil

   c. Succimer

   d. EDTA

d. Diazepam

5. Coma cocktail, except

   a. Thiamine

   b. Naloxone

   c. IV dextrose

   d. Diazepam

a. Sodium Thiosulfate for cyanide toxicity

6. Which of the ff is a chemical antidote

   a. Sodium Thiosulfate for cyanide toxicity

   b. atropine for physostigmine poisoning

   c. EP for anaphylaxis

   d. glucagon for beta-blocker activity

a. Naloxone

7. antidote for opioid poisoning

   a. Naloxone

   b. Flumazenil

   c. Deferoxamine

   d. EDTA

B. Wernicke-Korsakoff syndrome

8. Vitamin B1 or Thiamine Prevents

   a. parkinsonism

   B. Wernicke-Korsakoff syndrome

   c. Histamine Flushing

   d. Disulfiram syndrome

a. EDTA

9. which of the ff is a chelator?

   a. EDTA

   b. activated carbon

   c. Tannic acid

   d. Gastric Lavage

• Airway – prevent hypoxia

• Breathing – normal breathing (12-20 breaths/min)

• CPR – compression

• Life threatening affects:

  o   Heart Problem

  o   Shock

Initial assessment for management of poisoned patients:

Coma Cocktail

for patients w/ depressed mental status use:

• IV dextrose

• Naloxone

• Thiamine

components of coma cocktail:

IV dextrose

antidote for hypoglycemia

• Rapid removal of px from environment (fresh air)

• Give 100% oxygen & assisted ventilation

Management for Inhalational Exposure

• Remove the contaminated material from px

• Give slightly cool water (dilutional therapy)

Management for Dermal Exposure

• Give NSS irrigation for 15 mins

• DO NOT NEUTRALIZE

Management for Ocular Exposure

PEG or Polyethylene Glycol

Antidote for Whole Bowel Irrigation

• Poorly adsorbed (Fe, Pb, Li)

• Body packers of illicit drugs

• Delayed Released Drugs (SR)

Whole Bowel Irrigation Inidications:

• Renally excreted

• Low Vd

• Little-Protein Binding

• Acidic poisons → give basic (NaHCO3)

• Basic poisons → give acidic (NH4Cl or Vit C)

FORCED DIURESIS & URINARY pH MANIPULATION are for substances that are:

Hemodialysis

• Use of hemodialysis machine and a special filter called dialyzer (artificial kidney)

• For drugs that are renally excreted

Ethylene Glycol, Methanol, Theophylline, ASA, Barbiturates

Examples of Hemodialysis

Hemoperfusion

• prevents blood clotting | faster than hemodialysis, but rarely used

• Passage of anticoagulated blood through a column containing activated charcoal or resin particles

Phenobarbital, Phenytoin, Carbamazepine

Examples of Hemoperfusion

Competitive Antidotes

• Poison binds to active site

• Antidote binds to active site

Competitive Antidotes

Atropine + Acetylcholine is an example of:

Non-Competitive Antidotes

• Poison binds to the active same

• Antidote binds to the allosteric site (conformational change in active site)

Non-Competitive Antidotes

Bicuculin + Diazepam is an example of

Physiologic Antidotes

• fractional antidotes

• Two drugs activate different receptors, resulting to opposite effects

Physiologic Antidotes

Epinephrine for Anaphylaxes is an example of

BAL/Dimercapriol

Antidotes for As, Hg, Pb, Sb, Au

EDTA

Antidotes for SEVERE Pb, Mn, Zn

Deferoxamine

Antidotes for Fe, Al

Penicillamine

Antidotes for Cu, Pb, Hg

Succimer

Antidotes for mild Pb, As, Hg

Cd, Fe, Se

BAL is contraindicated to:

• Gastric Lavage

• Adsorbents

• Cathartics

• Emetics

• Precipitants

Mechanical Antidotes:

Gastric Lavage

• Stomach Wash

• For: Not alert or diminished gag reflex & Px who are seen early following massive ingestions

• Acids, Base, HCs

• Combative px

• At risk of GI Perforcition

Gastric Lavage is contraindicated to:

Adsorbents

• Form physical complexes w/ poison

• Use of activated carbon or charcoal

Cathartics

• Induce evacuation of bowel

• Ex. MgO – saline cathartics

Emetics

• Use of Ipecac syrup

• Not used anymore

Precipitants

• Alter the poison by forming an insoluble substance

• Ex. Tannic Acid

• MgO – 1 part | induction of catharsis

• Activated Charcoal – 2 parts | adsorption

• Tannic Acid – 1 part | ppt of poison

Components of Universal Antidote: