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Questions and Answers
What is the first step in the management of an intoxicated patient?
What is the first step in the management of an intoxicated patient?
Which of the following is NOT a component of the general approach to acutely poisoned patients?
Which of the following is NOT a component of the general approach to acutely poisoned patients?
What is included in the coma cocktail for treating suspected opioid-induced respiratory compromise?
What is included in the coma cocktail for treating suspected opioid-induced respiratory compromise?
What should be administered after diazepam if there is no response to treat seizures?
What should be administered after diazepam if there is no response to treat seizures?
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Which of the following methods is correct for maintaining an open airway?
Which of the following methods is correct for maintaining an open airway?
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What should be administered for hypotension in an intoxicated patient?
What should be administered for hypotension in an intoxicated patient?
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What is an important consideration when administering anticonvulsants?
What is an important consideration when administering anticonvulsants?
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Which of the following is NOT a part of the supportive therapy in poisoning treatment?
Which of the following is NOT a part of the supportive therapy in poisoning treatment?
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Which of the following steps is NOT part of the secondary assessment for diagnosing poisoning?
Which of the following steps is NOT part of the secondary assessment for diagnosing poisoning?
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What does the term 'toxidromes' refer to in the context of poisoning assessment?
What does the term 'toxidromes' refer to in the context of poisoning assessment?
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Which of the following odors is commonly associated with cyanide poisoning?
Which of the following odors is commonly associated with cyanide poisoning?
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After exposure to a poison, which factor is NOT typically assessed during the secondary evaluation?
After exposure to a poison, which factor is NOT typically assessed during the secondary evaluation?
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Which of the following tests is specifically designed to measure levels of particular drugs in the bloodstream during poisoning investigations?
Which of the following tests is specifically designed to measure levels of particular drugs in the bloodstream during poisoning investigations?
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What is a key reason to perform skin decontamination in cases of poisoning?
What is a key reason to perform skin decontamination in cases of poisoning?
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During the assessment process, how frequently should a patient's vital signs and mental status be monitored?
During the assessment process, how frequently should a patient's vital signs and mental status be monitored?
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Which of the following symptoms would indicate physiologic depression during a poisoning case?
Which of the following symptoms would indicate physiologic depression during a poisoning case?
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What should be done first in the event of eye exposure to a contaminant?
What should be done first in the event of eye exposure to a contaminant?
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Which situation would contraindicate the use of activated charcoal?
Which situation would contraindicate the use of activated charcoal?
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What is the primary action of activated charcoal in the treatment of poison ingestion?
What is the primary action of activated charcoal in the treatment of poison ingestion?
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For which type of poisoning would surgery or endoscopy be considered a viable option?
For which type of poisoning would surgery or endoscopy be considered a viable option?
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Which method is NOT effective for enhancing the elimination of poisons?
Which method is NOT effective for enhancing the elimination of poisons?
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What is a correct indication for performing gastrointestinal decontamination?
What is a correct indication for performing gastrointestinal decontamination?
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Which type of agents cannot be effectively adsorbed by activated charcoal, denoted by the acronym PHAILS?
Which type of agents cannot be effectively adsorbed by activated charcoal, denoted by the acronym PHAILS?
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What should be the immediate response for an individual suffering from inhalation of irritant gases?
What should be the immediate response for an individual suffering from inhalation of irritant gases?
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Study Notes
General Approach to Acutely Poisoned Patients
- The presentation is about a general approach to acutely poisoned patients.
- The lecturer is Dr. Nada Seliem, a lecturer of clinical toxicology at Cairo University.
Types of Poisoning
- Ingestion
- Inhalation
- Injection
- Dermal
Classification of Poisons
- Poisons are classified by source (plant, animal, chemical toxins), state (solid, liquid, gaseous), action (local, remote, dual), and target organ.
- CNS stimulants include amphetamines and cocaine.
- CNS depressants include hypnotics, narcotics, and alcohol.
- Gastrointestinal (GI) tract poisons include metals and corrosives (e.g., mercury, phenol, cadmium).
- Kidney poisons include paracetamol, iron, carbon tetrachloride.
- Liver poisons include digitalis and aconitine.
- Cardiovascular System (CVS) poisons include digitalis and aconitine.
- Lung poisons include toxic fumes.
Management of Intoxicated Patients
- Airway: Ensure clear airway.
- Breathing: Observe breathing patterns and administer oxygen if needed.
- Circulation: Monitor pulse and blood pressure.
- Diagnosis & decontamination: Evaluate to identify the poison.
- Elimination: Remove the poison through appropriate methods.
- Find antidote: Identify and administer the antidote if available.
- General management (supportive): General supportive care.
General Lines of Poisoning Treatment
- Supportive therapy (1st aid): Focus on treating the patient based on their symptoms not just the poison.
- Decontamination& Dialysis.
- Antidotes
Primary Assessment (Airway, Breathing, Circulation)
- Ensure an open airway (gag & cough reflexes, clear the airway, airway devices or intubation).
- Observe breathing (normal breathing, pulse oximetry, ABGs, administer oxygen).
- Monitor circulation (pulse, blood pressure, ECG monitoring, insert IV lines).
Secondary Assessment: Diagnosis
- Detailed History (type of poison, amount, quantity, route of exposure, reason, symptom onset time, prior treatment).
- Detailed clinical examination.
- Clinical Laboratory tests.
- Including checking for vital signs, mental status, and pupil size regularly.
- Specific toxidromes to look for suggest specific drug classes (physiologic excitation, depression, odors).
- Consider recent ingestion of toxins and the type.
Danger Signs
- No breathing
- Wheezy or noisy breathing
- Pulse below 50 BPM or above 110 BPM, irregular, or weak
- Non-reacting pupils
- Loss of consciousness
- Continuous seizures
- Temperature > 39°C (mouth/rectum) or 38°C (armpit)
- Severe abdominal tenderness
- Anuria
- Asterixis
Investigations
- Routine tests: Blood glucose, electrolytes, renal function, liver function, ABGs, and CBC.
- Specific tests: Drug levels for specific poisons (Acetaminophen, salicylates, digoxin, carbamazepine, phenobarbital, phenytoin, valproate, theophylline, iron, lithium).
- X-Rays (CXR, AXR) for diagnosing causes.
Decontamination
- Skin: Remove contaminated clothing, flush with copious water or saline (avoid rubbing).
- Eyes: Flush eyes with water, instill anesthetic eye drops if available, remove contact lenses.
- Inhalation: Remove from exposure area, provide supplemental oxygen, assess ventilation.
- GI decontamination: Gastric lavage, activated charcoal, cathartics, whole bowel irrigation if appropriate.
Contraindications for GI Decontamination
- Recent ingestion of toxins (usually within 1-2 hours).
- Agents not absorbed by activated charcoal.
- Corrosive, frothy substances.
- Coma
- Convulsions.
- Perforation.
Single Dose of Activated Charcoal (AC)
- Reduces systemic absorption of drugs.
- Enhances elimination by disrupting enterohepatic recirculation.
- Dose: 1-2 gm/kg in adults, 0.5-1 gm/kg in children.
Agents for which AC is not effective
- Pestisides
- Hydrocarbons
- Acids
- Alkalis
- Alcohols
- Iron
- Heavy metals
- Lithium and inorganic ions (e.g., fluoride, iodide)
- Solvents
Enhancement of Elimination
- MDAC (Multi-drug activated charcoal)
- Diuresis, manipulation of urine pH, hemodialysis, and hemoperfusion.
Surgery and Endoscopy
- Occasionally used for decontamination if other methods fail.
- Used for body packers and bezoar formation.
Find Antidote
- Medications (associated with the specific poison).
Take Home Message
- Treat patient, not the poison.
- Supportive care is crucial.
- Never use salty water (H2O) for decontamination.
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Description
This quiz focuses on the general approach to managing acutely poisoned patients, including types of poisoning and classifications of poisons. Learn about various management strategies and the importance of assessing airway and breathing in toxicology. Ideal for students of clinical toxicology and related fields.
