PRINCIPLES APPROACH AND DICTUM MNEMONIC ANS DISCUSSION COMMON POISONINGS ANTIDOTES SUMMARY

1. Topic :- Update on TOXICOLOGY AND DRUGS(2020)
Dr Rahul JainDr Sharda Jain
for Gynaecologist & Surgery Specialist

2. Over 400 ppts are available on
slideshare.net ***for use of public/Doctors
www.slideshare.net / Lifecarecentre

3. CONTENTS
• PRINCIPLES
• APPROACH AND DICTUM
• MNEMONIC
• ANS DISCUSSION
• COMMON POISONINGS
• ANTIDOTES SUMMARY

4. PRINCIPLES OF RX-
SUPPORT OF VITAL SIGNS
• TO MAINTAIN HOMEOSTASIS
• TO PREVENT SECONDARY
COMPLICATIONS(PNEUMONIA,CEREBRAL
EDEMA,BEDSORES,ARRYTHMIA,DVT,HYPOXIA,
RENAL FAILURE,COAGULOPATHY,SEPSIS)

5. PRINCIPLES(CONTD)-
REDUCTION OF ABSORPTION OF TOXINS-
• INHALTIONAL EXPOSURE-O2 SUPPORT
• DERMAL EXPOSURE-CLOTHES CHANGE AND
SHOWER
• EYE EXPOSURE-CONTINOUS IRRIGATION OF
EYE BY PLENTY OF SALINE
• ORAL EXPOSURE-EMESIS,GASTRIC
LAVAGE,ACTIVATED CHARCOL,WHOLE BOWEL
IRRIGATION

6. • EMESIS-FORCED EMESIS(SALINE,SYRUP OF
IPECAC)
• GASTRIC LAVAGE-ASPIRATION F/B
REINSTILLATION OF FLUID F/B REASPIRATION
DONE IN LEFT LATERAL
I. C/I-COMA PATIENT,CORROSIVE
POISONING,KEROSENE POSIONING(ASPIRATION
PNEUMONIA,PERFORATION)
• ACTIVATED CHARCOL-GIVEN VIA NG TUBE @
12.5GM/H(50-100GM)
• ENDOSCOPIC REMOVAL

7. PRINCIPLES(CONTD)-
• ENHANCEMENT OF POISON ELIMINATION-
1. ONLY FOR ECF DISTRIBUTED DRUGS
2. ALKALINIZATION OF URINE FOR ACIDIC
DRUGS(ASPIRIN,SALICYLATES,METHOTREXATE)
3. HAEMODIALYSIS

8. APPROACH-
• AIRWAY(INTUBATION IF REQUIRED)
1. GAG REFLEX
2. POSITION OF PATIENT
3. SUCTION
• BREATHING
1. ABG
2. BAG AND MASK VENTILATION
3. O2 SUPPORT

9. • CIRCULATION
1. BP MEASUREMENT
2. PULSE
3. OBTAINING IV LINE
4. ECG
5. ROUTINE BLOOD
INVESTIGATIONS(CBC,PERIPHERAL SMEAR,S
LYTES,KFT,LFT,GRBS)
• ALTERED MENTAL STATUS
1. RECOGNIZE/TREAT HYPOGLYCEMIA
2. RECTAL TEMPERATURE
3. SEIZURES CONTROL
4. AGITATION CONTROL

10. • DIAGNOSIS OF POISONING
1. HISTORY
2. ALLERGY
3. PHYSICAL EXAMINATION
4. ABG REPORT ANALYSIS AND ELECTROLYTE
CORRECTION
5. ASSOCIATED RENAL FAILURE
6. TOX SCREEN

12. • DECONTAMINATION
1. WASHING OF SKIN
2. ACTIVATED CHARCOL
3. GASTRIC LAVAGE
4. WHOLE BOWEL IRRIGATION
• ENHANCED ELIMINATION
1. HAEMODIALYSIS
2. REPEAT CHARCOL
• PSYCHIATRIC CONSULTATION(IF SUICIDAL)

13. MNEMONIC-
• A-AIRWAY
• B-BREATHING
• C-CIRCULATION
• D-DIAZEPAM FOR SEIZURES
• E-ELECTROLYTES CHECK
• F-FLUIDS
• G-GLUCOSE
• H-HYPERTHERMIA OR PYREXIA

14. ANTI CHOLINERGIC SYMPTOMS
• SIMILAR TO SYMPATHETIC
STIMULATION
• ANTIHISTAMINES,TRICYCLIC
ANTIDEPRESSANTS,ATROPINE
• VITALS-↑HR,BP,RR,TEMP
• PUPILS-MYDRIATRIC
• OTHER FEATURES-DRY SKIN,
URINARY RETENTION

15. CHOLINERGIC SYMPTOMS-
• ORGANOPHOSPHATES,PESTICIDES

16. OP POSIONING TREATMENT-
FOLLOW THE DICTUM
ATROPINE(ANTIDOTE)-3MG BOLUS
• DOUBLE THE DOSE EVERY 5 MINS
• END POINTS –CLEAR CHEST,HR>100,PUPILS-
NORMAL
• START THE INFUSION
PRALIDOXIME
• REACTIVATES ACETYLCHOLINESTERASE
ENZYME

17. BENZODIAZEPINE POISONING-
• DIAZEPAM,LORAZEPAM,ALPRAZOLAM,CLONA
ZEPAM
• C/F-DROWSINESS,ATAXIA,WEAKNESS,SLURRED
SPEECH.HYPOTENSION,RESPIRATORY
DEPRESSION,STUPOROUS,COMATOSE
• TREATMENT-
1. FOLLOW THE DICTUM
2. FLUMAZENIL INFUSION(1MG REVERSES
BZD),GIVEN AS 0.2MG/MIN UPTILL 3.5MG

18. SSRI POSIONING-
• SEROTONIN SYNDROME
• DRUGS-
SERTRALINE,PAROXETINE,ESCITALOPRAM,FLUOXE
TINE
• C/F-CONFUSION(SIMILAR TO ANTICHOLINERGIC
S/E)
• VITALS-↑BP,TEMP,PULSE,MYDRIASIS
DIAPHORESIS,NAUSEA AND VOMITTING
NEUROMUSCULAR -↑REFLEXES,RIGIDITY,TRISMUS
RX-CYPROHEPTADINE

19. DRUGS AND ANTIDOTES-
• PARACETAMOL-n ACETYL CYSTEINE
• CARBON MONOXIDE-HYPERBARIC OXYGEN
• HEPARIN-PROTAMINE SULPHATE
• METHANOL-ETHANOL,FOMEPIZOLE
• MORPHINE-NALOXONE
• HYPOGLYCEMICS-GLUCOSE
• WARFARIN-VIT K

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