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Questions and Answers
What is the most immediate priority in the management of a poisoned patient?
Which of the following factors can influence toxicity in a patient?
What critical aspect must be addressed to prevent death in a comatose poisoned patient?
Which treatment strategy is essential when dealing with an acutely poisoned patient?
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What is one possible outcome of cellular hypoxia in a poisoned patient?
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What is the primary goal when treating acute poisoning?
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Which of the following is NOT a contraindication for inducing emesis?
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Which of the following measures would be inappropriate for a patient who has ingested enteric-coated tablets more than one hour prior?
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What is the main purpose of using activated charcoal in poisoning management?
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In the approach to the poisoned patient, which of the following assessments is essential during the initial examination?
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Study Notes
Clinical Toxicology
- Fifth Stage 2024-2025
- Lecturer Salim Dawood
- Lec. 1+2
Learning Objectives
- Understand the general principles of clinical toxicology
- Recognize factors that influence toxicity
- Understand the initial approach to a poisoned patient, focusing on immediate priorities
- Recognize the importance of evaluating and preserving vital signs
- Understand the goals of treatment, focusing on treating the patient, not the poison, promptly
- Know and understand specific approaches for reducing the body burden of various poisons
- Know how to counteract toxicological effects at receptor sites, if possible
- Understand important treatment contraindications for preventing serious injury or death in patients
- Be aware of newer approaches and treatment modalities
- Know where to quickly obtain facts, specific antidotes, or other poison control information promptly
Common Causes of Death in the Acutely Poisoned Patient
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Comatose patients are susceptible to:
- Loss of protective reflexes
- Airway obstruction by flaccid tongue
- Aspiration of gastric contents into the tracheobronchial tree
- Loss of respiratory drive
- Respiratory arrest
- Hypotension due to depression of cardiac contractility
- Shock due to hemorrhage or internal bleeding
- Hypovolemia due to vomiting, diarrhea, or vascular collapse
- Hypothermia exacerbated by rapid administration of intravenous fluids at room temperature
- Cellular hypoxia despite adequate ventilation and oxygen administration, due to cyanide, carbon monoxide, or hydrogen sulfide poisoning
Approach to the Poisoned Patient
- History: Oral statements regarding details
- Call Poison Control Center: Retrieve drug labeling information
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Initial Physical Examination:
- Assessment of Vital Signs
- Eye Examination
- CNS and Mental Status Examination
- Examination of the Skin
- Mouth Examination
- Laboratory Tests: Clinical chemistry and x-ray procedures
- Renal function tests
- EKG
- Other Screening Tests
Treatment of Acute Poisoning
- Treat the patient, not the poison, promptly
- Supportive therapy is essential
- Maintain respiration and circulation as primary interventions
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Judge progress of intoxication by:
- Measuring and charting vital signs and reflexes
- 1st Goal: Keep the concentration of poison as low as possible by preventing absorption and increasing elimination
- 2nd Goal: Counteract toxicological effects at the effector site, if possible
Prevention of Absorption of Poison
- Decontamination from skin surface
- Emesis: Indicated after oral ingestion of most chemicals, considering the time since ingestion
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Contraindications of Emesis:
- Ingestion of corrosives such as strong acids or alkalis
- Comatose or delirious patients
- Ingestion of CNS stimulants or convulsing patients
- Ingestion of petroleum distillates
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Methods of Inducing Emesis:
- Mechanically by stroking the posterior pharynx
- Syrup of ipecac, 1 ounce followed by a glass of water
- Apomorphine parenterally
- Gastric Lavage: Insert tube into the stomach and wash with water or ½ normal saline to remove unabsorbed poison
- Contraindications of Gastric Lavage: Same as for emesis, except the procedure should not be attempted with young children
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Chemical Adsorption:
- Activated charcoal adsorbs many poisons, preventing absorption
- Do not use simultaneously with ipecac if the poison is excreted into bile in active form
- Adsorbent in the intestines may interrupt enterohepatic circulation
- Saline Cathartics: Sodium or magnesium sulfate
-
Purgation:
- Used for ingestion of enteric-coated tablets when the time after ingestion exceeds one hour
- Use saline cathartics such as sodium or magnesium sulfate
-
Chemical Inactivation:
- Not generally done, particularly for acids, bases, or inhalation exposure
- For ocular and dermal exposure and skin burns, treat with copious water
-
Alteration of Biotransformation:
- Interfere with the metabolic conversion of a compound to a toxic metabolite
- Metabolism of some compounds produces highly reactive electrophilic intermediates; if nucleophiles are present, toxicity is minimal; if nucleophiles are depleted, toxicity results
- Increasing Urinary Excretion: Through acidification or alkalinization
- Decreasing Passive Resorption: From the nephron lumen
- Diuresis
- Cathartics
- Peritoneal Dialysis
- **Hemodialysis **
- Hemoperfusion
Strategies for Treatment of the Poisoned Patient
- Evaluate and stabilize vital signs
- Give supportive therapy, if needed
- Determine the type and specifics of the poison
- Determine the time of exposure
- Determine the presumed current location of the poison
- Determine the volume of distribution and Ki for the poison.
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Description
This quiz is designed for students in the fifth stage of clinical toxicology, focusing on the critical principles and practices necessary for the effective treatment of poisoned patients. Participants will explore factors influencing toxicity, evaluation of vital signs, and essential treatment approaches. Gain knowledge about specific antidotes and recent modalities in toxicology.
