Treatment of Ingested Poisons.

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  • Place the infant or young child in the supine position, and have an assistant restrain the child and flex the head slightly.Select the appropriate tube. Determine the length to be passed by measuring the distance for the manubrium sterni to the xiphisternum. Double this and add 5cm. Mark the appropriate length on the tube.
  • Introduce the selected length and fix the tube lightly to the cheek. Aspirate the tube and test the contents with litmus (blue to red indicates acid). If no fluid is obtained advance the tube 3cm and try again. If still unsuccessful, inject 3m of normal saline. Withdraw the tube if this causes coughing.
  • Using a syringe, draw sterile 0.9% NaCl for lavage from a 20ml ampoule: 5 –10 mls for babies less than 1 year and 10-20 mls for babies older than 1 year. Inject NaCl into the stomach through the tube and leave for 2-3mins.
  • Treatment of Ingested Poisons.

    1. 1. Forensic Chemistry 1
    2. 2. Poison; Substance which when introduced into or applied to the body, is capable of injuring health and destroying life.Ingested poisons… 2
    3. 3. Preliminary examinations...Removal of unabsorbed poison:- 1) Administration of milk and water. 2) Induced Emesis. 3) Gastric Lavage. 4) Activated Charcoal. 5) Whole Bowel Irrigation. 6) Cathartics. 7) Endoscopic/ Surgical removal. 8) Oral Binding Agents. 3
    4. 4. Timing: within few minutes of ingestion.Action: Diluting poison Demulsifying poison.Effectiveness: for alkalis and weak acids.Limitation: not for phosphorus and strong acids. 4
    5. 5. Timing: within 1 hour of ingestion.Action:  Mechanical stimulation; posterior pharyngeal wall.  Chemical induction; syrup of ipecac.Ipecac; “Cephali ipecacuanha” Contain „emetine & cephaline‟. Directly irritates gastro-intestinal mucosa… 5
    6. 6. Dosage: Children 15ml Adult 30mlLimitation: not an effective method to remove poison.Contraindications: Obtunded, comatose or convulsing patients. CNS depressants; camphor, cocaine, tricyclic anti depressants. Corrosive agents.Adverse effects: Persistent vomiting. May promote passage of toxic material into small intestine. 6
    7. 7. Advantages: has greater efficacy. Less aversive and invasive. Preferred method.Activity: Is highly adsorbent powdered material. Owing to large surface area, it is highly effective in adsorbing toxins.Dosage: Ten times the amount of poison ingested. 1-2 g/kg of body weight. 7
    8. 8. Palatability may be increased by adding sweetener (sorbitol) or a flavoring agent.Limitations: Charged chemicals i.e. mineral acids, alkalis and highly dissociated salts of cyanide, fluoride, iron, lithium.Adverse effects: Stomach cramps, vomiting, constipation etc. Pulmonary aspiration. 8
    9. 9. Timings: about 4 hours of ingestion.Effectiveness: Preferred method. Instilled to one dose of activated charcoal. Ingestion of phenothiazine, antihistamines, tricyclic antidepressants/Salicylates as they delay gastric emptying. 9
    10. 10. Adult: Children:Stomach tube. Ryle‟s tube.12.7mm diameter. Narrower Cali bore.1.5 m length. Shorter length. Funnel at upper end of tube. Suction bulb to suck out fluid. Lower end is blunt to avoid injury. Tube lubricated with liquid paraffin/ glycerin. 10
    11. 11. 11
    12. 12. 12
    13. 13. 13
    14. 14. Limitations: Undissolved pills or pill fragments. Enteric-coated products. May hasten movement of drugs and poisons in small intestine.Contraindications: Obtunded, comatose, convulsing patients. Ingestion of sustained-release & enteric- coated tablets.Adverse effects: Perforation of esophagus / stomach. Nosebleed from trauma during passage of tube. 14
    15. 15. Activity: Administrating cleansing solutions: Non absorbable polyethylene glycol in a balanced electrolyte solution.Dosage: 0.5 L/h in child. 2 L/h in adult.Contraindications: Intestinal obstructions. Obtunded, comatose or convulsing patients. 15
    16. 16. Advantage: Ingested foreign body. Packets of illicit drugs. Slow release / enteric coated medications. Agents poorly adsorbed by charcoal like heavy metals.Adverse effects: Nausea and bloating. 16
    17. 17. Sorbitol, Magnesium citrate, Sodium sulfate.Dosage: 1-2 g / kg of body weight.Usage: Prevent constipation. Hasten passage of iron tablets.Contraindications: Intestinal obstructions.Adverse effects: Severe fluid loss. Abdominal cramping and vomiting. 17
    18. 18. Useful in rare cases.Drug-filled packets.Intact tablets or tablet concretions.Potential lethal amount of heavy metals. 18
    19. 19. To trap toxins in gut.Drug / Toxin: Binding Agent:Calcium : Cellulose Sodium Phosphate.Chlorinated hydrocarbons : Cholestyramine resin.Iron : Sodium bicarbonate.Thallium : Prussian blue.Digitoxin : Cholestyramine resin. 19
    20. 20. “Substance which can counteract the effect of poisoning.”Origin: Greek, antididonai; “given against”Requirement: Poison may have not fully removed by emesis or gastric lavage. These procedures are contraindicated. Poisons is already adsorbed. Poison has been administered by route other than ingestion. 20
    21. 21. Physical / Mechanical antidote: Demulcents. Adsorbents. Diluents. Bulky food.Chemical antidote: Weak non carbonate alkalis. Weak vegetable acids. Potassium permanganate.Physiological or Pharmacological antidote. 21
    22. 22. Universal antidotes: Constituent: Quantity: Purpose: Powdered charcoal 2 parts absorb alkaloid. Magnesium oxide 1 part neutralizes acids. Tannic acid 1 part ppt. alkaloids, glycoside. 22
    23. 23. Agent: Indication:Activated charcoal with sorbitol. Used for oral toxins.Calcium chloride. Calcium channel blocker.Cyanide antidote (amyl Cyanide poisoning.nitrite, sodium nitrite, thiosulfate)Protamine sulfate. Heparin poisoning.Prussian blue. Thallium poisoning. 23
    24. 24. Strong liquid tea….Starch….Milk….Flour suspension / mashed potatoes….Milk of Magnesia….Orange / lemon juice / vinegar…. 24
    25. 25. Have recovered!Thanks! 25

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