General principles involved in management of poisoning (Part 1)

This powerpoint deals with a part of general principles in the management of poisoning. Mainly deals with AIRWAY and BREATHING related problems.

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 musclesDepression of central respiratory
drive (CNS Depression)
Botulinum toxin Antihistamines
NMBs Barbiturates
Nicotine Clonidine
Organophosphates & carbamatesEthanol
Snakebite Opioids
Tetrodotoxin (found in puffer fish)Phenothiazine antipsychotics
Sedative-hypnotics
TCAs
How to treat ventilatory poisoning?
Endotracheal intubation

6. HYPOXIA:
Hypoxiaisaconditioninwhichthebodyoraregionofthe
bodyisdeprivedofadequateoxygensupplyatthetissue
level
CausesofHYPOXIA:
Inert gases Cardiogenic
pulmonary
edema
Cellular hypoxiaPneumonia/ non-
cardiogenic
pulmonary edema
CO2 Beta-blockersCO 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 reactionsSmoke 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.