Lecture 18: Basic Approach to Tx or Poisoned Animals

What are the 6 basic steps to poisoning treatment?

1. stabilize

2. clinical evaluation: hx, PE, baseline diagnostics

3. decontamination

4. enhance elimination

5. antidote

6. symptomatic and supportive care

What is the goal of the stabilization step?

keep animal alive long enough to make a diagnosis and begin treatment

What are the most important immediate life-threatening conditions to consider when stabilizing?

• ABCs (airway, breathing, circulation)

• seizures

• shock

• severe hypothermia, hyperthermia

• severe hypoglycemia

• severe electrolyte abnormalities

When stabilizing a patient, you check their ABCs and notice the patient is having difficulty breathing. What are your options to stabilize?

intubation, oxygen, mechanical ventilation

When stabilizing a patient, you check their ABCs and notice the patient has poor circulation. What are your options to stabilize?

fluids, cardiac and vascular support, oxygen

What is the goal of the clinical evaluation step?

determine the patient’s condition (including severity) and how to treat

When does the clinical evaluation step begin?

as soon as you see the patient or talk to the owner

What should be done if the toxin is known for proper clinical evaluation?

have owner bring in package or label and determine the exposure dosage if possible

When should baseline diagnostic samples be taken?

BEFORE treatment if possible for later testing if needed

What is the minimum diagnostics that should be done in a clinical evaluation of a toxicosis case?

in-house CBC, biochemical profile, urinalysis

What is the goal of the symptomatic and supportive care step?

to restore or preserve homeostasis

What toxicity treatment step is unique to poison cases?

decontamination

What is the goal of decontamination?

decrease total amount of toxin absorbed

What are the methods of decontamination?

• physically remove what you can

• attempt to bind up what you cannot remove

• speed removal of what is left in the system

What are the methods of ocular decontamination?

• copious flushing with warm water or saline

• stain cornea after lavage

What are the methods for dermal decontamination?

• bathing with mild hand soap or shampoo → NOT automatic dishwasher detergent or laundry detergent, avoid hypothermia

• if asphalt, tar, sticky traps etc: shave, hand degreasing agents (ex. gojo), butter or vegetable oil → wash off degreaser or oil so animal does not ingest

• clipping coats, brushing or vacuuming (risk of inhalation)

What problems can oral exposures cause?

• absorption across MMs

• taste reaction: especially in cats (frothing, drool, etc)

• contact irriation/corrosive burns

What are the methods of oral decontamination?

rinse mouth out thoroughly, empty cheek pouches if rodent

Why are species differences important in GI decontamination?

• vomiting abilities

• amount of toxin likely to be ingested

• type of toxin likely to be ingested