Management Of The Poisoned Patient Primary Assessment PDF

Management of the poisoned patient Primary Assessment The initial management of a patient with coma, seizures, or altered mental status should follow the same approach regardless of the poison involved: supportive measures are the basics (“ABCDs”) of poisoning treatment. ...

Management of the poisoned patient Primary Assessment The initial management of a patient with coma, seizures, or altered mental status should follow the same approach regardless of the poison involved: supportive measures are the basics (“ABCDs”) of poisoning treatment.  A- The airway First, the airway should be: Cleared of vomitus or any other obstruction Endotracheal tube inserted if needed. For many patients, simple positioning in the lateral, left-side-down position is sufficient to move the flaccid tongue out of the airway.  B- Breathing Breathing difficulties are the major cause of morbidity and mortality in poisoned patients. Assess and treat ventilatory failure, hypoxia and bronchospasm. Breathing should be assessed by observation and pulse oximetry and by measuring arterial blood gases. Patients with respiratory insufficiency should be intubated and mechanically ventilated.  C- The circulation The circulation should be assessed by continuous monitoring of: Pulse rate (CPR if no pulse) Blood pressure Urinary output Evaluation of peripheral perfusion. An intravenous line should be placed and blood drawn for serum glucose and other routine determinations.  D- Disability (Nervous system) Determine the level of consciousness using the AVPU method: A = Alert, V = Responds to verbal stimuli, P = Responds to painful stimuli and U = Unresponsive. Patient with altered mental status should receive: 1- Concentrated dextrose, unless a rapid blood glucose test demonstrates that the patient is not hypoglycemic. 2- Treat seizures with Diazepam, Lorazepam or Phenobarbitone. 3- Naloxone for patient with suspected opioid- induced respiratory compromise. 4- Patients with life-threatening hyperthermia (temperature > 40°C or >104°F), should be treated immediately by: a) Start external cooling with tepid water sponging, (to bring the temperature to 38.6°C). b) Exclude other causes of hyperthermia (drug withdrawal, heat stroke, thyrotoxicosis, meningitis, encephalitis, or other systemic infections). c) For malignant hyperthermia, administer Dantrolene (1-10 mg/kg IV). d) In case of anticholinergic poisoning, antidote treatment may reduce hyperthermia. 5 - Alcoholic or malnourished patients should also receive 100 mg of thiamine im or IV. infusion to prevent Wernicke Korsakoff syndrome. brain disorder