GENERAL MANAGEMNT OF POISONING PATIENTS.pptx

General management of poisonings

1. GENERAL MANAGEMNT OF POISONING PATIENTS

2. DECONTAMINATION OCULAR DECONTAMINATION SKIN DECONTAMINATION GASTRIC DECONTAMINATION

3. OCULAR DECONTAMINATION Wash with either water or crystalloid solution Affected eye should be down May require local anesthetic (e.g., 0.5% tetracaine) instillation and lid retractors to facilitate copious irrigation In case of corrosive poisoning ,ten minutes after irrigation (allowing equilibration of crystalloid and conjunctival sac pH), conjunctival sac pH is tested. Irrigation continues until pH is between 7.2 and 7.4

4. SKIN DECONTAMINATION • Shower/rapid wash with a bucket of water • Look out for the toxic particles under the nails, groin, genitalia, behind the ears, hair • Remove any contaminated clothing

5. GI DECONTAMINATION Emesis ( OBSELETE NOW ) Orogastric lavage Single dose activated charcoal Whole bowel irrigation

6. OROGASTRIC LAVAGE PROCEDURE Left lateral position. Use Ryle’s tube If there is potential airway compromise, endotracheal or nasotracheal intubation should precede orogastric lavage First aspirate the stomach contents and store the first content for medico legal purpose Use normal saline or clean tap water, infuse 250 ml at time and aspirate. Repeat process till the aspirate is clear.

7. WHOLE BOWEL IRRIGATION Polyethylene glycol is an osmotically balanced electrolyte solution. Administration in large quantities mechanically forces substances through the GI tract, limiting toxin absorption

8. ACTIVATED CHARCOAL Toxins within the GI lumen are adsorbed onto the activated charcoal and carried through the GI tract, limiting absorption. Activated charcoal can be administered to intubated patients using an orogastric or nasogastric tube. INDICATIONS carbamazepine (most common) dapsone phenobarbitone quinine theophyline ( hemodialysis is more important)

9. ENHANCED ELIMINATION MULTI DOSE ACTIVATED CHARCOAL URINARY ALKALIZATION EXTRACORPOREAL ELMINATION Severe toxicity Poor outcome despite good supportive care/antidote administration Slow endogenous rates of elimination Suitable pharmacokinetic properties

10. MULTI DOSE ACTIVATED CHARCOAL Multidose activated charcoal increases elimination of toxins with enteroenteric , enterohepatic, or enterogastric recirculation Give repeat doses of 25 g (0.5 g/kg in children) every two hours Multidose activated charcoal should not be given when bowel sounds are absent.

11. URINARY ALKALIZATION  Alkaline urine pH promotes the ionisation of acidic drugs This prevents reabsorption across the renal tubular epithelium thus promoting excretion in the urine To be effective the drug must be filtered at the glomerulus, have a small volume of distribution and be a weak acid

12. HAEMODIALYSIS

13. HAEMOPERFUSION

14. CRRT