a emergency treatment of poisoning.describe of ingested poisons,inhaled poisons,absorbed poison,food poisoning,injected poisoning,snake bite. management of treatment

1. POISONING
SUBMITTED TO SUBMITTED BY
MRS. BEATRICE ABIGAIL KOYEL THANDER
LECTURER OF NHCON 2ND PBBSC

2. INTRODUCTION
 A poison is any substance that, when ingested, inhaled, absorbed,
applied to the skin, or produced with in the body in relatively small
amounts, injures the body by its chemical action.
 The branch of medicine that deals with the detection and treatment of
poison is known toxicology.

3. DEFINITION
• Poison is a substance ( solid/ liquid or gaseous ) , which if introduced in
the living body, or brought into contact with any part there of, will produce
ill health or death, by its constitutional or local effects or both.”

4. TYPES OF POISONING
1. Ingested (swallowed) poisons
2. Inhaled poisons: carbonmonoxide poisoning
3. Absorbed : skin contamination of poisoning (chemical poison)
4. Food poisoning
5. Injected poison :stinging insect
6. Snake bites

5. Ingested poison
 Ingested poison are those that have been swallowed.
It includes
 common house hold and industrial chemicals,
 medications,
 inproperly prepared foods,
 plant materials,
 petroleum products and agricultural products made specifically to control
rodents, weeds ,insects and crop diseases.

6. Sign and symptoms of ingested
poison:
 Nausea and vomiting
 Burns on around the lips
 Drowsiness
 Deep and rapid breathing
 Sometimes with increasing fever
 Slow pulse
 Excessive salivation
 Sweating and nausea
 Diarrhoea
 Difficulty breathing

7. Patient care – ingested poison
Emergency care step:
 Detect and treat immediately life threating problem in the initial assessment .
Evaluate the need for the prompt transport for critical patients.
 Perform a focused history and physical exam including sample history . Used
gloves hand to carefully removed any pills or fragments from the patient
mouth.
 Asses the baseline vitals signs.
 Consult medicine direction, administers activated charcoals or water or milk to
dilute it.
 Transport the patient with all containers , bottles and labels from the substance.
 Perform ongoing assessment enroute.

8.  Inhaled poison are those that have been inhaling or breath in.
 Take the form of gases, vapours and sprays again many of these substances are
in common use in the home, industry (from car exhaust , wood burning ,stoves
and furnaces )
INHALED POISON

9. Carbon monoxide:
Carbon monoxide is one of the most common inhaled poisons, usually associated
with motor vehicle exhaust and fire suppression.
carbon monoxide exerts its toxic effect
By binding to circulating HB and thereby
Reducing the oxygen carrying capacity of the blood
HB absorbs carbon monoxide 200 times more rapidly than oxygen

10. Signs of carbon monoxide:
 Headache
 Nausea
 Breathlessness
 Collapse
 Dizziness
 Loss of consciousness
 Cyanosis
 Palpitation
 Muscle weakness

11. Investigation of inhaled poison:
 History :exposure history
 Acute unconsciousness/acute metabolic acidosis
 Pulse oximetry may over estimation oxygen saturation thus ABG should be
used.
 Confirmation: carboxyhemoglobin

12. MANAGEMENT
GOAL : To reverse the cerebral and myocardial hypoxia.
INTERVENTION:
 Carry the patient to fresh air immediately ,open all doors and windows.
 Loosen all tight clothes.
 Initiate CPR if required administer 100% oxygen.
 Prevent chilling : wrap the patient blanket.
 Keep patient quite as possible.

13. Skin contamination of poisoning
(chemical poison)
Skin contamination injuries from exposure to chemicals are challenging because
of the large number of offending agents with diverse actions and metabolic
effects. The severity of chemical burn is determined by the mechanisms of
action, the penetrating strength and concentration ,and the amount and
duration of exposure of the skin to chemical .

14. Investigation of absorb the poison
 History: exposure history
 Inspection – skin burn or colour changes of skin

15. MANAGEMENT
GOAL: Prevent skin from exposure.
INTERVENTION:
 The skin should be drenched immediately with running water from a shower,
hose, o r faucet.
 The skin of health care personnel assisting the patient should be appropriately
protected if the burn is extensive or if the agent is significantly toxic or is still
present.
 Prolonged lavage with generous amounts of tepid water is important.
 In the meantime, attempts to determine the identity and characteristics of the
chemical agent are necessary for future treatment.

16. CONTD:
 The standard burn treatment appropriate for the size and location of the
wound(antimicrobial treatment, débridement, tetanus prophylaxis as
prescribed) is instituted.
 Plastic surgery for further wound management.

17. FOOD POISIONING
• Food poisoning is a sudden illness that occurs after ingestion of
contamination of food or drink.
• Botulism is a serious form of food poisoning that requires continual
surveillance.

18. It may be caused by:
 – bacteria or their toxins
 – chemicals including metals
 – plants or fish
 – viruses
 – mycotoxins

19. HIGH RISK OF FOOD
– Cooked poultry
– Cooked meats
– Dairy produce (milk, cream, etc.)– Soups, sauces and stocks
– Shellfish, sea food
– Cooked rice
– Dishes containing eggs.

20. LOW RISK OF FOOD
– Dried or pickled Foods
– Chemically-preserved foods
– Foods with high sugar content
– Food with high salt content

22. ASSESMENT
 Determine the source and type of food poisoning (suspected food,
history ).
 Collect and assess food, gastric contents, vomitus, serum, and feces.
 Assess fluid and electrolyte balance. (Severe vomiting produces alkalosis,
and severe diarrhea produces acidosis)
 Assess for Hypovolemic shock ( Lethargy, rapid pulse rate, fever, oliguria,
anuria ,hypotension , and delirium)
 Assess weight and serum electrolyte

23. MANAGEMENT
 Monitor respirations, blood pressure, sensorium , CVP (if indicated),and
muscular activity.
 Measures are instituted to support the respiratory system (respiratory paralysis
can occur with botulism, fish poisoning , and other food poisonings)
 An antiemetic medication is administered parenterally. For mild nausea, the
patient is encouraged to take
 sips of weak tea, carbonated drinks,or tap water.
 After nausea and vomiting subside, clear liquids are usually prescribed for 12
to 24 hours, and the diet is gradually progressed to a low-residue, bland diet.

24. CONTD:
 Use of drugs for the relief of pain & IV fluids to alleviate dehydration.
(Staphylococcus -Should not be treated with antibiotics
 E.Coli, Botulism - For life threatening infection, transfusions& kidney dialysis

25. INJECTED POISONS :STINGING
INSECT
 A person may have an extreme sensitivity to the venoms of the
Hymenoptera (bees, hornets, yellow jackets, fire ants, and wasps).
 Venom allergy (IgE – mediated reaction)
 Although stings in any area of the body can trigger anaphylaxis, s tings of
the head and neck are especially serious.

26. Clinical manifestation
o Generalized urticaria
o Itching
o Malaise
o Anxiety
o Laryngeal edema to severe bronchospasm
o Shock
o Death

27. Management
 Stinger removal.
 Wound care with soap and water is sufficient for stings.
 Scratching is avoided because it results in a histamine response.
 Ice application reduces swelling and also decreases venom absorption.
 An oral antihistamine and analgesic will decrease the itching and pain.
 In the case of an anaphylactic response, epinephrine (aqueous) is injected
subcutaneously (not intravenously)

28. SNAKE BITES
 Venomous snake bites are medical emergencies.

29. Contd:
 Snake venom consists primarily of proteins with a broad range of
physiologic effects. Multiple organ systems, especially the neurologic,
cardiovascular, and respiratory systems, may be affected.

32. MANAGEMENT
 Allow the victim should lie down.
 Remove constrictive items such as rings, provide warmth.
 Cleanse the wound, cover the wound with a light sterile dressing.
 Immobilize the injured body part below the level of the heart.
 Observe the sequence of events, signs and symptoms (fang punctures, pain,
edema, and erythema of the bite and nearby tissues).
 Assess laboratory data (complete blood count, urinalysis , and clotting studies)
 Generally ice, tourniquets, heparin, and corticosteroids are not used during the
acute stage.

33. Contd:
 Corticosteroids are contraindicated in the first 6 to 8 hours after the bite,
because they may depress antibody production and hinder the action of
antivenin(antitoxinmanu factured from the snake venom and used to treat
snakebites).
 Parenteral fluids m ay be used to treat hypotension.
 Vasopressors are used to treat hypotension.
 Surgical exploration of the bite is rarely indicated.
 Observed closely for at least 6 hours.
 The patient is never left unattended

34. Administration of antivenin (antitoxin)
 Antivenin, which is most effective if administered with in 12 hours after the
snake bite.
 A skin or eye test should be performed before the initial dose to detect
allergy to the antivenin . However, because even the skin test can cause an
anaphylactic reaction, patients Should not be tested unless antiveninis to
be given.
 Administer Inj.TT
 Premedication with diphenhydramine and cimetidine decreases the allergic
response to antivenin.
 Antivenin is administered as an intravenous infusion whenever possible,
although intramuscular administration can be used. (The antivenin is
diluted in 500 to 1000 mL of normal saline solution)

35. Fundamental of poisoning
management
1. Initial resuscitation and stabilization.
2. Removal of toxin from the body.
3. Prevention of further poison absorption.
4. Enhancement of poison elimination.
5. Administration of antidote.
6. Supportive treatment.
7. Prevention of re-exposure.

36. • 1. Initial resuscitation & stabilization :
 • First priorities are ABC’s.
 IV access – IV fluid.
 Endo tracheal intubation - to prevent aspiration
a. Unconscious patients
b. Respiratory depression/ failure
 Convulsions- give anticonvulsants

37. 2.Removal of Toxin :
 Copious flushing with water or saline of the body including skin folds, hair.
 • Inhalational exposure
✓Fresh air or oxygen inhalation

38. 3. Prevention of poison absorption :
• 1. Gastric Lavage
 • Done with water ,1:5000 potassium permanganate , 4% Tannic acid,
saturatedlime wate ror starch solution with orogastric or Ewald’s tube.
 • Performed until clear fluid is obtained or a maximum of 3 L
 Contraindications:
✓o Corrosive poisoning
✓o Recent esophageal / gastric surgery
✓o Unconscious patient

39. 3. Prevention of poison absorption
 Ipecac Syrup induced emesis .administered orally.
 Contraindications:
 corrosives
 CNS depression
 Rapidly acting CNS poisons ( cyanide, strychnine, camphor )or seizures

40. 3. Prevention of poison absorption
3.Activated Charcoal:
Charcoal absorbs ingested poisons within gut lumen allowing charcoal-
toxin complex to be evacuated with stoolor removed by induced emesis /
lavage.
Dose – 1 g/kg body wt.
Given orally as a suspension ( in water ) or
through NG tube.
Contraindications:
• Mineral acids, alkalis, cyanide, fluoride ,iron

41. 3. Prevention of poison absorption
 4. Whole bowel irrigation
 Administration of bowel cleansing solution containing electrolytes &
polyethylene glycol.
 Orally or through gastric tube.
 Rate – 2 L/hr. ( 0.5 L /hr. in children)
 End point- rectal fluid is clear.
 Position – sitting
Contraindications :
a) Bowel obstruction
b) Ileus
c) Unprotected airway

42. 4.Enhancement of Elimination of
Poison
• Forced alkaline diuresis
 • Infusion of large amount of NS + NAHCO3
 Serious fluid and electrolytes disturbance may occur
 Need expert monitor
Acidification of urine
Enhance elimination of weak bases such as
Phencyclidine & Amphetamine

43. 4.Enhancement of Elimination of
poison
 Extracorporeal removal
dialysis– peritoneal dialysis.
 alcohols , long acting salicylates ,lithium
• chelation
• Heavy metal poisoning
• Complex of agent & metal is water soluble & excreted by kidneys

44. 5.Administration of Antidote
 • Not all poisons have antidotes
 Typical Examples are mentioned only

45. 6.Supportive management
1. Control of the airway, ventilation, and oxygenation are
essential.
2. In the absence of cerebral or renal damage, the patient's prognosis depends largely on
successful management of respiration and circulation.
3. Measures are instituted to stabilize cardiovascular and other body functions.
4. ECG, vital signs, and neurologic status are monitored closely for changes.
5. An indwelling urinary catheter is inserted to monitor renal function.
6. Measures are instituted to remove the toxin or decrease its absorption.
7. The patient who has ingested a corrosive poison, which
can be a strong acid or alkaline substance, is given water or
milk to drink for dilution.
• 8.Symptomatic management

46. 7.Prevention:
• Keep the household products and medications out of the reach of
children.
• Use childproof safety caps on containers of medications and other
potentially dangerous substances.
• Keep products in their original containers.
• Use poison symbols to identify dangerous substances.
• Dispose of outdated medications an household products.

47. NURSING DIAGNOSIS

48. Reference
 Text book of medical surgical nursing by “Burnner and suddarth’s” 12th
edition ,vol-2, Lippincott 2017-2019 page no- 2160-2163
 Text book of medical surgical nursing by “javed Ansari and davinder “2nd
edition vol 2 page no–
 www.who.org