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General principles involved in management of poisoning (Part 1)
1. GENERAL PRINCIPLES INVOLVED IN
MANAGEMENT OF POISONING- I
Dr. Vishnu R Nair,
PharmD, RPh, Dip. (Nutrition),
Assistant
Professor (Dept. of Pharmacy
Practice),
NIMS Institute of
Pharmacy.
2. WHAT IS CLINICAL TOXICOLOGY?
Branch of science, that deals with PATLET of
poison/poisoning
PATLET means:
i. P: Properties of poison
ii. A: Action of poison
iii. T: Toxicity of poison (poisoning features)
iv. L: Lethal dose
v. E: Estimation (How to confirm a particular
poisoning?)
vi. T: Treatment of the poisoning.
WHAT IS POISON?
Refers to any substance injected into living body by any
means (oral, i.v, inhalation/ dermal) causes local/systemic
effects (or even both) results in ill-effects/ death of the
individual.
3. GENERAL PRINCIPLES OF
POISONING MANAGEMENT:
Includes the following major headings:
i. STABILIZATION & EVALUATION
ii. GUT DECONTAMINATION
iii. POISON ELIMINATION
iv. ANTIDOTE ADMINISTRATION
v. NURSING CARE
vi. PSYCHIATRIC CARE.
STABILIZATION & EVALUATION:
Refers to assessment & correction of life-threatening
problems associated with the poisoning
Always pay attention to ABCD of RESUSCITATION:
A: Airway
B: Breathing
C: Circulation
D: Depression of CNS.
4. AIRWAY:
Causes of death from airway block:
i. Airway obstruction
ii. Pulmonary aspiration of gastric contents
iii. Respiratory arrest.
Treatment involves:
i. Optimize airway position to force the flaccid tongue
out.
ii. Maximize airway opening (clear/suction airway)
iii. Perform endotracheal intubation (nasotracheal/
orotracheal)
iv. https://www.youtube.com/watch?v=qzIyTCx1Mfw
(watch for nasotracheal intubation)
v. https://www.youtube.com/watch?v=-5UVpGjXZcI
(watch for orotracheal intubation)
ENDOTRACHEAL INTUBATION TECHNIQUES
5. BREATHING:
Breathing difficulties contribute to morbidity &
mortality in patients with poisoning
Issues related to breathing include ventilatory failure,
hypoxia & bronchospasm.
VENTILATORY FAILURE:
Causes of VENTILATORY FAILURE:
Paralysis of ventilatory muscles Depression of central respiratory
drive (CNS Depression)
Botulinum toxin Antihistamines
NMBs Barbiturates
Nicotine Clonidine
Organophosphates & carbamates Ethanol
Snakebite Opioids
Tetrodotoxin (found in puffer fish) Phenothiazine antipsychotics
Sedative-hypnotics
TCAs
How to treat ventilatory poisoning?
Endotracheal intubation
6. HYPOXIA:
Hypoxia is a condition in which the body or a region of the
body is deprived of adequate oxygen supply at the tissue
level
Causes of HYPOXIA:
Inert gases Cardiogenic
pulmonary
edema
Cellular hypoxia Pneumonia/ non-
cardiogenic
pulmonary edema
CO2 Beta-blockers CO Aspiration of gastric
contents
Methane Quinidine CN Aspiration of
hydrocarbons
Nitrogen TCAs Cocaine
Verapamil Opioids
Procainamide Sedative-hypnotics
Smoke inhalation
How to treat hypoxia?
i. Administer supplemental oxygen as required
ii. Intubation (in serious cases)
iii. Treat pneumonia with antibiotics (if evidence of
infection).
7. BRONCHOSPASM:
Defined as a condition in which the lung muscles tighten
restricts airflow makes breathing difficult!
Causes of BRONCHOSPASM:
Beta-receptor antagonists Organophosphate poisoning
Chlorine gas Dust particles
Drugs that cause allergic reactions Smoke inhalation
Hydrocarbon aspiration
How to treat bronchospasm?
Administer supplemental oxygen
Endotracheal intubation (if serious)
Discontinue the offending drug or agent causing
bronchospasm
Remove patient from source of exposure to irritant gas/
dust particulate
Give beta-2 agonist:
- Beta-2-agonist relaxes bronchial pathways
causes bronchodilatation
- Salbutamol (5-15 mg, over 1-hour nebulization)
For excessive cholinergic stimulation:
- Give anticholinergic (ipratropium bromide, 0.5 mg,
every 4-6 hrs)
8. - Cholinergic overstimulation increases secretion in
respiratory pathways causes bronchospasm
- Anticholinergic reverses cholinergic effect
(hypersecretion in airways) reduces
bronchospasm.
For hyperreactive airways give inhaled/ oral steroids
(anti-inflammatory effect)
For bronchospasm due to
organophosphate/carbamate/other pesticide poisoning:
i. Give atropine i.v (anticholinergic)
ii. Ipratropium bromide (anticholinergic) may also
be helpful.