Workshop, Toxicology

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  • د / أحمد عبدالستار المركز القومي لتنمية قدرات هيئة التدريس والقيادات
  • د / أحمد عبدالستار المركز القومي لتنمية قدرات هيئة التدريس والقيادات
  • Workshop, Toxicology

    1. 1. بسم الله الرحمن الرحيم
    2. 2. PRINCIPLES OF POISONING MANAGEMENT
    3. 3. Tanta poison center Address: Emergency hospital, Faculty of medicine, Tanta. Telephone: 0185103132 Administrative line : 3350373 Website: http://www.facebook.com/#!/home.php?sk=group_1 58174004241467 http://www.tanta.edu.eg/ar/medicine1/FMCT/ctu/index.html
    4. 4. تعارف
    5. 5. تعالوا نتفق الأول الابتسامة الأسئلة المنظمة المحمول الحوارات الجانبية
    6. 6. الهدف العام <ul><li>تزويد المتدربين بالمعارف و المهارات و الاتجاهات اللازمة للتعامل مع حالات التسمم </li></ul>
    7. 7. Program <ul><li>Lecture </li></ul><ul><li>Case solving & Competition </li></ul><ul><li>Evaluation of the workshop </li></ul><ul><li>Transfer training </li></ul>
    8. 8. <ul><li>Pre-Test </li></ul>
    9. 9. Role 1: <ul><li>It is better to do NOTHING than to harm the patient. </li></ul>
    10. 10. Role 2: <ul><li>All poisoned patients should be treated as potentially LIFE-THREATENING CONDITIONS , even though if they appear not so ill. </li></ul>
    11. 11. طيب .. حتعمل ايه ؟؟ <ul><li>1- Primary survey: </li></ul><ul><li>Rapid recognition of critical illness. </li></ul><ul><li>2- Resuscitation: </li></ul><ul><li>A irway, B reathing, C irculation, C oma, C onvulsions </li></ul><ul><li>3- Secondary survey: </li></ul><ul><li>History, examination & investigations . </li></ul><ul><li>4- Definitive care and monitoring: </li></ul><ul><ul><li>Decontamination </li></ul></ul><ul><ul><li>Specific Antidotes </li></ul></ul><ul><ul><li>Enhancement of Elimination </li></ul></ul><ul><ul><li>Symptomatic treatment </li></ul></ul>
    12. 12. Snake Co Corrosives Hydrocarbons O.P Home First Aid For Common Poisons Coma
    13. 13. Diagnosis Of Poisoning <ul><li>Physical Examination </li></ul><ul><li>Toxidromes </li></ul><ul><ul><li>Types & Examples </li></ul></ul><ul><ul><li>D.D. </li></ul></ul><ul><ul><li>Importance </li></ul></ul><ul><li>Investigations </li></ul><ul><ul><li>Laboratory </li></ul></ul><ul><ul><li>Radiologic </li></ul></ul><ul><li>History </li></ul><ul><ul><li>Benefits </li></ul></ul><ul><ul><li>& </li></ul></ul><ul><ul><li>Problem </li></ul></ul>
    14. 14. DIAGNOSIS OF POISONING <ul><li>History : </li></ul><ul><ul><li>Benefits </li></ul></ul><ul><ul><li>& </li></ul></ul><ul><ul><li>Problem </li></ul></ul>
    15. 15. Circumstantial evidences <ul><li>Sudden appearance of toxic manifestations in a group of persons after taking certain food or drink. </li></ul><ul><li>Presence of bottle of tablets or insecticide near the victim. </li></ul><ul><li>Presence of suicidal note. </li></ul>Prof Dr Ashraf M. Emara
    16. 16. History Prof Dr Ashraf M. Emara
    17. 17. Important history <ul><li>Which Poisons were ingested? </li></ul><ul><li>- Coingestants (ethanol, BZD, TCA) </li></ul><ul><li>- Drug formulations (-SR) </li></ul><ul><li>What amount was ingested? </li></ul><ul><li>When were the drugs ingested? </li></ul><ul><li>Accidental vs. intentional? </li></ul>
    18. 18. Personal history Prof Dr Ashraf M. Emara
    19. 19. Name Identification Reassurance Follow up Prof Dr Ashraf M. Emara
    20. 20. Age Infant, child and old age more risky to poisoning. Prof Dr Ashraf M. Emara
    21. 21. Age of the person 31/12/11 Prof Dr Ashraf M. Emara
    22. 22. Sex Females are more risky to poisoning than males. Prof Dr Ashraf M. Emara
    23. 23. Residence Persons are housing near source of pollution. Prof Dr Ashraf M. Emara
    24. 24. Occupation Workers: occupational exposure. Prof Dr Ashraf M. Emara
    25. 25. Marital state Divorced women Failure in Exam or love 7-1-2010 Prof Dr Ashraf M. Emara
    26. 26. Special habits Smoking Addiction Prof Dr Ashraf M. Emara
    27. 27. Socioeconomic state Low standard Prof Dr Ashraf M. Emara
    28. 28. Toxicological history Amount: Frequency: Period of exposure: Form: Time passed since administration: Prof Dr Ashraf M. Emara
    29. 29. Past history Pervious history of poisoning . Pervious attempts of suicide . Any medical diseases ( kidney, liver ). Any surgical operation ( gastric ). Prof Dr Ashraf M. Emara
    30. 30. Family history Congenital disease ( glucose 6 phosphate dehydrogenase deficiency ). Prof Dr Ashraf M. Emara
    31. 31. Complaint It taking by patient's own wards (try to avoid medical terms) or from relatives in case of disturbed consciousness. Prof Dr Ashraf M. Emara
    32. 32. <ul><li>AVOID medical terms: </li></ul><ul><ul><li>Bluish discoloration of skin not Cyanosis </li></ul></ul><ul><ul><li>Coughing of blood not Haemoptysis </li></ul></ul><ul><ul><li>Vomiting of blood not Haematemsis </li></ul></ul><ul><li>AVOID leading questions e.g. </li></ul><ul><ul><li>No chest pain </li></ul></ul><ul><ul><li>No vomiting </li></ul></ul>31/12/11 Prof Dr Ashraf M. Emara
    33. 33. Present history Prof Dr Ashraf M. Emara
    34. 34. Onset: Acute, Chronic Duration: (when were your last quite well). Course: (progressive, regressive, stationary). Prof Dr Ashraf M. Emara
    35. 35. Physical examination <ul><ul><li>Any patient presented by multi-system affection should be considered as a case of poisoning till proved otherwise. </li></ul></ul>
    36. 36. Toxidromes <ul><li>A group of S&S pointing to ….. </li></ul>
    37. 37. Cholinergic Syndrome <ul><li>DUM B EL S </li></ul><ul><li>D efecation </li></ul><ul><li>U rination </li></ul><ul><li>M iosis </li></ul><ul><li>B ronchospasm, B ronchorrhea, B radycardia </li></ul><ul><li>E mesis </li></ul><ul><li>L acrimation </li></ul><ul><li>S alivation, S weating </li></ul>
    38. 38. <ul><li>SLUDGE </li></ul><ul><li>S alivation </li></ul><ul><li>L acrimation </li></ul><ul><li>U rination </li></ul><ul><li>D iaphoresis </li></ul><ul><li>G I upset </li></ul><ul><li>E mesis </li></ul>Cholinergic Syndrome
    39. 39. Examples: <ul><li>Organophosphates </li></ul><ul><li>Carbamates </li></ul><ul><li>Pilocarpine </li></ul>
    40. 40. Anticholinergic Syndrome <ul><li>ABCDE </li></ul><ul><li>A gitation & hallucinations </li></ul><ul><li>B lurred vision & mydriasis </li></ul><ul><li>C onvulsions </li></ul><ul><li>D ryness (skin, constipation, urine retention) </li></ul><ul><li>E levated temperature & heart rate </li></ul>
    41. 41. Anticholinergic Syndrome (DRY as a bone) Dry skin (RED as a beet) Flushed (HOT as a hare) Hyperthermia
    42. 42. Anticholinergic Syndrome (BLIND as a bat) Dilated pupils (MAD as a hatter) Hallucinations (Flappy as a bird) Tachycardia
    43. 43. (Full as Container) Urinary retention Anticholinergic Syndrome
    44. 44. Examples: <ul><li>Atropine </li></ul><ul><li>Antihistamines </li></ul><ul><li>Benztropine </li></ul><ul><li>Cyclic Antidepressants </li></ul>
    45. 45. Sympathomimetic Syndrome MATHS <ul><li>M ydriasis </li></ul><ul><li>A gitation </li></ul><ul><li>T achycardia </li></ul><ul><li>H ypertension - H yperthermia </li></ul><ul><li>S eizures - S weating </li></ul>
    46. 46. Sympathomimetic Syndrome <ul><li>Mimics Anticholinergic except WET compared to dry; </li></ul><ul><ul><li>Sweating </li></ul></ul><ul><ul><li>Defecation. </li></ul></ul>
    47. 47. Examples: <ul><li>Cocaine </li></ul><ul><li>Amphetamines </li></ul><ul><li>Phencyclidine </li></ul><ul><li>Pseudoephedrine </li></ul>
    48. 48. Opioid Syndrome ( CPR ) <ul><li>Triad of: </li></ul><ul><ul><li>C onsciousness: depressed </li></ul></ul><ul><ul><li>P upils: pinpoint </li></ul></ul><ul><ul><li>R espiration: depressed </li></ul></ul><ul><li>Also see: </li></ul><ul><ul><li>Decreased blood pressure </li></ul></ul><ul><ul><li>Decreased temperature </li></ul></ul><ul><ul><li>Decreased reflexes </li></ul></ul>
    49. 49. Examples: <ul><li>Heroin </li></ul><ul><li>Morphine </li></ul><ul><li>Codeine </li></ul><ul><li>Methadone </li></ul>
    50. 50. Importance : <ul><li>Faster diagnosis </li></ul><ul><li>Faster initiation of therapy. </li></ul>
    51. 51. <ul><li>The patient presentation may be atypical : </li></ul><ul><ul><ul><li>Delay </li></ul></ul></ul><ul><ul><ul><li>Multiple </li></ul></ul></ul>
    52. 52. Investigations Laboratory Radiology
    53. 56. Quiz ….. <ul><li>جائزة لأول مجموعة تجاوب صح </li></ul>
    54. 57. Name the toxidrome <ul><li>A 17 year old male with a history of behavioral problems at school presents to the emergency department after a suicide attempt. He was noted to be hallucinating earlier, and had a convulsion prior to arrival. </li></ul><ul><li>Physical Examination: </li></ul><ul><li>Arousable to loud verbal stimulus. He moves his extremities spontaneously. </li></ul><ul><li>Pulse: 120 RR: 20 BP: 125/80 Temp: 40 </li></ul><ul><li>Pupils: Dilated & Fixed </li></ul><ul><li>Lungs: NAD </li></ul><ul><li>Abdomen: Markedly decreased bowel sounds, fullness in the suprapubic area </li></ul><ul><li>Skin: Slightly flushed, dry </li></ul><ul><li>Neuro: hyperreflexia </li></ul>
    55. 58. Toxidrome <ul><li>Anticholinergic </li></ul>
    56. 59. C ase S tudy
    57. 60. <ul><li>An 18-year-old man presented to the hospital 4 hours after insecticide spaying . He complained of abdominal pain , appeared lethargic , weak , and had vomited at least once. His vital signs were notable for a heart rate of 60 beats/min , Bl pr 90/60 mmHg , and a respiratory rate of 30 breaths / min with frothy secretions from the mouth and nose. The pupils were constricted. </li></ul>
    58. 61. الحاله دى إيه ☻
    59. 62. Cholinergic Toxidrom <ul><li>Organophosphates </li></ul>
    60. 63. كفااااااااااااااااااية Ahmad El-Ebiary
    61. 64. Take home message
    62. 65. Take home message <ul><li>Suspect poisoning if multisystem involvement. </li></ul><ul><li>Treat the patient not the poison. </li></ul><ul><li>Consider contraindications & complications before an action. </li></ul><ul><li>Dispose off the patient properly. </li></ul><ul><li>Consider psychiatric care. </li></ul>
    63. 66. حد يلخصهم تاني .... ممكن؟
    64. 68. شكرا لكم 00

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