Expt. 1 - Post Lab General Measure in Poisoning Management

1. separate patient from the poison

2. give supportive therapy

3. give antidotes

general principles in poisoning management (3)

individual

Remove the _____ from the contaminated air if the toxic

substance is airborne.

clothing

Remove the person’s _____ immediately if it is soaked in the

poison.

vomiting, gastric lavage
caustic poisons, comatose patient

When the poison has been ingested induce ____ or use

_____ except when this is contraindicated, as in the

case of _____ or a _____

milk

most common available antidote in a household

milk

an amphoteric and both acids and bases are compatible

calcium, protein

Both the _____ and _____ in milk can serve as chelators

milk

coats the stomach thereby protecting it and delaying absorption

A - Airway

B - Breathing

C - Circulation

ABCs of poisoning stands for?

airway

should be cleared of vomitus or any other obstruction and an oral airway or endotracheal tube inserted if needed

breathing

should be assessed by observation and oximetry and if in doubt, measure arterial blood gases

respiratory insufficiency

In breathing, patient with _____ must be mechanically ventilated.

circulation

should be assessed by continuous monitoring of PR, BP, Urinary output and evaluation of peripheral perfusion

IV line

In circulation, ____ should be placed and blood drawn for

serum glucose and other routine determinations.

• mental status

• concentrated dextrose

• rapid bedside blood glucose

patient with _____ should be given _____, unless a ______ test demonstrates that the patient is not hypoglycemic

Laboratory and Imaging procedures

These tests may help diagnose or determine which substance caused the poisoning

urine / vomitus samples

samples that are essential in determining the poisonous substances

decontamination

should be undertaken simultaneously with initial stabilization, diagnostic assessment and laboratory evaluation

decontamination

involves removing toxins from the skin of the GI tract

10 to 15

In dermal decontamination, moving from head to toe, irrigate the exposed skin and hair for __ to __ minutes and scrub w/ a soft surgical sponge, being careful not to abrade the skin.

5 to 10

In dermal decontamination, irrigate wounds for an additional __ to __ minutes with water or saline

emesis

to induce vomiting

syrup of ipecac

an emetic recommended to induce vomiting. best administered with a glass of warm water because this produces contents

aspiration pneumonia

Syrup of Ipecac (or any emetic) must be used with a particular caution when CNS integrity is compromised because of the risk of ______

salt water, finger

Giving ____ or using the ____ to tickle the throat to promote emesis are both dangerous.

gastric lavage

useful in treating poisoning by aromatic substances, such as perfume, or when some contraindication for emesis exists.

airway protective reflexes

The performance of gastric lavage is contraindicated in any person who demonstrates compromised ______, unless they are intubated

activated charcoal

adsorbs the poison or toxin and delays gastrointestinal absorption. It is specially helpful in the treatment of poisoning from aromatic and alkaloid compounds

1, 50

a dose of charcoal given ___ hour after ingestion can absorb about ___% of that poison.

cathartics

used to hasten the removal of a toxic, substance and are useful for ingestion of hydrocarbons and enteric-coated tablets

sodium sulfate

frequently used cathartic

Whole bowel irrigation (WBI)

emerged as the newest technique in gastrointestinal decontamination. It involves the enteral administration of an osmotically balanced polyethylene glycol-electrolyte solution (PEGES) to flush the drug or chemical rapidly through the bowel.

peritoneal dialysis

simple and available dialysis technique but inefficient in removing most drugs.

hemodialysis

more efficient than peritoneal dialysis. It assists in correction of fluid and electrolyte imbalance and may enhance removal of toxic metabolites.

urinary alkalinization

useful in cases of salicylate overdose

antidote

agents which neutralize or countered the effect of a poison

single-dose activated charcoal

For general measures in antidotes, ______ is the preferred method in many cases

10:1

activated charcoal is used in a ____ ratio

50, 1

the usual dose of activated charcoal is __ g for an adult and __ g/kg for children

gastric lavage

used in cases where medications have been ingested that activated charcoal would absorb poorly

activated charcoal

an effective non-specific adsorbent

• charcoal

• tannic acid

• magnesium oxide

the classic universal antidote consisted of?

• vasomotor collapse

• reflex inhibition

severe pain causes ____ and ____ of normal physiologic function

morphine sulfate

it can cause nausea and vomiting, CNS depression, and slowing of respiration. It must be used cautiously

Meperidine hydrochloride (Demerol)

causes less nausea and vomiting than morphine sulfate.

• edema

• pulmonary edema

Excess of water or salt intake over loss in the presence of impaired kidney functions leads to _____and _____

inadequate

____ water intake impairs the ability of functioning kidneys to excrete toxic substances

ventilation

In respiratory acidosis, ____ must be improved in order to eliminate retained carbon dioxide

sodium bicarbonate

In metabolic acidosis, the metabolic processes must be altered to reduce the production of ______

• diazepam (valium)

• phenobarbital

most commonly used in convulsions (2)

stimulants

drugs contraindicated with coma

diazepam, paraldehyde, and chlorpromazine

drugs used to treat hyperactivity, delirium and mania

glucose, epinephrine, glucagon

drugs used to treat hypoglycemia

immediate resuscitation with administration of air or O2 until normal respiration returns

treatment for hypoxia and depresses respiration

pulmonary edema

this is due to inhalation of irritants

primary shock

characterized by fanning or collapse with low blood pressure

secondary shock (delayed/refractory shock)

characterized by cold, pale, cyanotic skin, sweating, rapid pulse and low blood pressure. May develop in almost any type of severe poisoning but is especially common after poisoning with corrosive substances or depressants

CHF

resulting from poisons that produce myocardial damage

poisoning

refers to the development of dose related adverse effects following exposure to chemicals, drugs, xenobiotics or any substance which when administered, inhaled or swallowed is capable of creating deleterious effects on the body

self-poisoning

exposure to one’s self by ingestion or inhalation to an amount of substance associated with the significant potential to cause harm.

Accidental Poisoning

involves a person, usually a young child, unintentionally poisoning themselves without wanting to cause harm to their body.