Propranolol is the most common beta-blocker involved in severe beta-blocker poisoning. It is nonselective and can lead to CNS depression, seizures, and prolongation of the QRS complex.
Beta blocker toxicity is notably distinguished by bradycardia, low respiratory
rate and hypoglycemia
Seizures and other CNS effects can occur with beta blockers that can cross the blood brain barrier (more rarely with the other beta blockers)
Overdoses of beta blockers with a combination of other drugs can have wide
ranging systemic effects
If within a short time after ingestion, give activated charcoal
Treat with glucagon to raise blood glucose levels
Widely used treatment is currently Atropine though it is considered less effective
Treat bronchospasm with beta agonists like Albuterol
Treat Seizures with Benzodiazepines like Valium
If the patient is still unresponsive or the condition is still deteriorating, treat with epinephrine
Gut decontamination or methods of poison removal in clinical toxicology Soujanya Pharm.D
This presentation includes various methods of poison removal like emesis, gastric lavage (stomach wash), catharsis, activated charcoal, whole bowel irrigation.
Propranolol is the most common beta-blocker involved in severe beta-blocker poisoning. It is nonselective and can lead to CNS depression, seizures, and prolongation of the QRS complex.
Beta blocker toxicity is notably distinguished by bradycardia, low respiratory
rate and hypoglycemia
Seizures and other CNS effects can occur with beta blockers that can cross the blood brain barrier (more rarely with the other beta blockers)
Overdoses of beta blockers with a combination of other drugs can have wide
ranging systemic effects
If within a short time after ingestion, give activated charcoal
Treat with glucagon to raise blood glucose levels
Widely used treatment is currently Atropine though it is considered less effective
Treat bronchospasm with beta agonists like Albuterol
Treat Seizures with Benzodiazepines like Valium
If the patient is still unresponsive or the condition is still deteriorating, treat with epinephrine
Gut decontamination or methods of poison removal in clinical toxicology Soujanya Pharm.D
This presentation includes various methods of poison removal like emesis, gastric lavage (stomach wash), catharsis, activated charcoal, whole bowel irrigation.
Dental Implant 1 /certified fixed orthodontic courses by Indian dental academy Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
00919248678078
CLINICAL MANAGEMENT OF DENTAL PATIENTS ON MULTIPLE DRUG THERAPY /cosmetic den...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
What is bronchiolitis and its definition, the age group, signs and symptoms and clinical presentation The clinical practice guidelines, how to diagnosis, clinical criteria, what are the severity degrees and How to assess the severity, what are the investigations that may be needed, Is there any diagnostic test, what is the prognosis
What is the management,
De-challenge and rechallenge are terms used in pharmacovigilance to describe the occurrence and recurrence of adverse drug reactions (ADRs) in relation to the administration of a particular drug.
De-challenge refers to the cessation or reduction of symptoms or adverse events after discontinuation or reduction of the drug. In other words, de-challenge occurs when the patient's symptoms improve or disappear once the drug is stopped or the dose is reduced. A positive de-challenge suggests that the drug was likely the cause of the adverse event.
Rechallenge, on the other hand, occurs when the patient's symptoms or adverse events recur after the drug is reintroduced. In other words, rechallenge occurs when the patient experiences the same symptoms or adverse events after the drug is given again. A positive rechallenge suggests a strong likelihood that the drug is the cause of the adverse event.
De-challenge and rechallenge are important components of causality assessment, which is the process of determining whether a particular drug or medical intervention is the cause of an adverse event or reaction that has occurred in a patient. De-challenge and rechallenge data can provide valuable information to help assess the likelihood of a causal relationship between the drug and the adverse event.
However, it is important to note that de-challenge and rechallenge data should be interpreted cautiously and in the context of other factors such as temporal relationship, biological plausibility, and alternative explanations. A positive de-challenge or rechallenge does not necessarily indicate a causal relationship between the drug and the adverse event, but rather provides additional evidence to support or refute the likelihood of such a relationship.
Practitioners and researchers must always rely on their own experience and knowledge in evaluating
and using any information, methods, compounds, or experiments described herein. In using such
information or methods they should be mindful of their own safety and the safety of others, including
parties for whom they have a professional responsibility.
With respect to any drug or pharmaceutical products identified, readers are advised to check the most
current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be
administered, to verify the recommended dose or formula, the method and duration of administration,
and contraindications. It is the responsibility of practitioners, relying on their own experience and
knowledge of their patients, to make diagnoses, to determine dosages and the best treatment for each
individual patient, and to take all appropriate safety precautions.
To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume
any liability for any injury and/or damage to persons or property as a matter of products liability,
negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas
contained in the material herein.
Clinical toxicology /certified fixed orthodontic courses by Indian dental aca...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
MANAGEMENT OF ORAL LICHEN PLANUS WITH TOPICAL TACROLIMUS. A PROSPECTIVE STUDY...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
definition of malnutrition, the definition of protein-energy malnutrition , the etiology 0f protein-energy malnutrition, the pathophysiology of malnutrition, features of marasmus, features of kwashiorkor, vitamins and micronutrient deficiencies, signs of micronutrients deficiency, diagnosis, management of malnutrition,prognosis of malnutrition ,prevention of malnutrition
Definition of erythema infectiosum, the causative factor, clinical presentation, the three stages of rash, the slipped cheek, the sequences of the rash, the diagnosis of the fifth disease, the differential diagnosis of fifth disease, the treatment of erythema infectiosum, the prognosis of fifth disease , congenital erythema infectiosum, the complications of fifth disease , Human parvovirus B19
What is kingella kingae bacterium,features of K. kingae,Species of Kingella,epidemiology of k. kingae,Proposed pathogenesis of K. kingae infections,Transmission of k. kingae ,Pathegenesis of k. kingae,diagnosis ,NAAT for k.kingae ,treatment of k.kingae,prevension ,osteomyelitis due to k,kingae.endocarditis due to k.kingae,Septic Arthritis due to k. kingae,Spondylodiscitis due to k. kingae, prevention of k. kingae infection
What is congenital nephrotic syndrome ,what is the definition of congenital nephrotic syndrome,what is the inheritance,what are the responsible genes ,what are the types of congenital nephrotic syndrome,what is the presentation ,diagnosis ,and treatment of congenital nephrotic syndrome, primary type and secondary type of congenital nephrotic syndrome
What is nonalcoholic fatty liver disease, what is the prevalence among children ,the definition of NAFLD,What are the relationship between obesity and over weight with the development of NAFLD,what are the sequences ,what is NASH,Who are at risk , How to diagnosis NAFLD what is the differential diagnosis ,what is the treatment
#what is listeriosis #,listeria monocytoges ,#what is the mode of transmission,#food-born infection ,#vertical infection ,#early and late onset ,#meningitis و#Sepsis ;#Early vs.Late onset neonatal listeriosis ,diagnosis of neonatal listeriosis ,treatment of neonatal listeriosis ,prevention of neonatal listeriosis
What is achondroplasia, definition , etiology ,types of dwarfism , genetic background,clinical presentations ,history and clinical examination , differential diagnosis ,diagnostic tests ,radiological findings ,CT scan and MRI , Medical care and role of growth hormone ,Surgical care and consultation,
Definition of neonatal sepsis,type of neonatal sepsis ,early onset neonatal sepsis,late onset neonatal sepsis,Pathophysiology of neonatal sepsis,,sign and symptoms of neonatal sepsis, diagnosis of neonatal sepsis,management of neonatal sepsis, antibiotic used for neonatal sepsis,prevention of neonatal sepsis, prognosis of neonatal sepsis ,and A summary
What is your knowledge regarding electrical burn in children,types of electrical burns in children.,characteristic features of each type ,minor electrical burn , high -voltage electrical burn ,lightning electrical burn what are the clinical presentations and management ,cardiac complication of electrical burn,neurological complication of electrical burn , cutaneous and oral complication ,masculoskeletal complication and ocular and renal complications
what is community acquired pneumonia(CAP),what is the prevalence of (CAP) ,what are the risk factors and what are the causative agents ,what are the clinical presentations ,how to diagnose it,what are the needed investigations ,what is the management ,what are the procedures to decrease the incidence,
definition what is FPIES, what it defers from other food allergy, what are the signs and symptoms ,what are the different types of food allergy ,how to diagnose FPIES ,what are the oral food challenge (OFC) ,what is the treatment , the prognosis of FPIES
What is influenza ,ethology ,types ,presentations signs and symptoms ,epidemic influenza ,laboratory investigations , management , the WHO guidelines in dealing with cases and contact
What is Fifth disease, what is erythema infectiosum What is the causative factor, pathophysiology ,clinical presentation ,diagnosis ,laboratory investigations ,treatment , precautions and prognosis ,
حساسية الجلد ماهي فوائد الجلد ماهي الحساسية ماهي انواع حساسية الجلد ماهي العوامل التي تؤدي لحدوث الحساسية ماهي انواع الحساسية ماهي اعراض الحساسية ماهي طرق الوقاية من الحساسية ماهو علاج الحساسية
In the vast landscape of cinema, stories have been told, retold, and reimagined in countless ways. At the heart of this narrative evolution lies the concept of a "remake". A successful remake allows us to revisit cherished tales through a fresh lens, often reflecting a different era's perspective or harnessing the power of advanced technology. Yet, the question remains, what makes a remake successful? Today, we will delve deeper into this subject, identifying the key ingredients that contribute to the success of a remake.
From Slave to Scourge: The Existential Choice of Django Unchained. The Philos...Rodney Thomas Jr
#SSAPhilosophy #DjangoUnchained #DjangoFreeman #ExistentialPhilosophy #Freedom #Identity #Justice #Courage #Rebellion #Transformation
Welcome to SSA Philosophy, your ultimate destination for diving deep into the profound philosophies of iconic characters from video games, movies, and TV shows. In this episode, we explore the powerful journey and existential philosophy of Django Freeman from Quentin Tarantino’s masterful film, "Django Unchained," in our video titled, "From Slave to Scourge: The Existential Choice of Django Unchained. The Philosophy of Django Freeman!"
From Slave to Scourge: The Existential Choice of Django Unchained – The Philosophy of Django Freeman!
Join me as we delve into the existential philosophy of Django Freeman, uncovering the profound lessons and timeless wisdom his character offers. Through his story, we find inspiration in the power of choice, the quest for justice, and the courage to defy oppression. Django Freeman’s philosophy is a testament to the human spirit’s unyielding drive for freedom and justice.
Don’t forget to like, comment, and subscribe to SSA Philosophy for more in-depth explorations of the philosophies behind your favorite characters. Hit the notification bell to stay updated on our latest videos. Let’s discover the principles that shape these icons and the profound lessons they offer.
Django Freeman’s story is one of the most compelling narratives of transformation and empowerment in cinema. A former slave turned relentless bounty hunter, Django’s journey is not just a physical liberation but an existential quest for identity, justice, and retribution. This video delves into the core philosophical elements that define Django’s character and the profound choices he makes throughout his journey.
Link to video: https://youtu.be/GszqrXk38qk
As a film director, I have always been awestruck by the magic of animation. Animation, a medium once considered solely for the amusement of children, has undergone a significant transformation over the years. Its evolution from a rudimentary form of entertainment to a sophisticated form of storytelling has stirred my creativity and expanded my vision, offering limitless possibilities in the realm of cinematic storytelling.
Skeem Saam in June 2024 available on ForumIsaac More
Monday, June 3, 2024 - Episode 241: Sergeant Rathebe nabs a top scammer in Turfloop. Meikie is furious at her uncle's reaction to the truth about Ntswaki.
Tuesday, June 4, 2024 - Episode 242: Babeile uncovers the truth behind Rathebe’s latest actions. Leeto's announcement shocks his employees, and Ntswaki’s ordeal haunts her family.
Wednesday, June 5, 2024 - Episode 243: Rathebe blocks Babeile from investigating further. Melita warns Eunice to stay clear of Mr. Kgomo.
Thursday, June 6, 2024 - Episode 244: Tbose surrenders to the police while an intruder meddles in his affairs. Rathebe's secret mission faces a setback.
Friday, June 7, 2024 - Episode 245: Rathebe’s antics reach Kganyago. Tbose dodges a bullet, but a nightmare looms. Mr. Kgomo accuses Melita of witchcraft.
Monday, June 10, 2024 - Episode 246: Ntswaki struggles on her first day back at school. Babeile is stunned by Rathebe’s romance with Bullet Mabuza.
Tuesday, June 11, 2024 - Episode 247: An unexpected turn halts Rathebe’s investigation. The press discovers Mr. Kgomo’s affair with a young employee.
Wednesday, June 12, 2024 - Episode 248: Rathebe chases a criminal, resorting to gunfire. Turf High is rife with tension and transfer threats.
Thursday, June 13, 2024 - Episode 249: Rathebe traps Kganyago. John warns Toby to stop harassing Ntswaki.
Friday, June 14, 2024 - Episode 250: Babeile is cleared to investigate Rathebe. Melita gains Mr. Kgomo’s trust, and Jacobeth devises a financial solution.
Monday, June 17, 2024 - Episode 251: Rathebe feels the pressure as Babeile closes in. Mr. Kgomo and Eunice clash. Jacobeth risks her safety in pursuit of Kganyago.
Tuesday, June 18, 2024 - Episode 252: Bullet Mabuza retaliates against Jacobeth. Pitsi inadvertently reveals his parents’ plans. Nkosi is shocked by Khwezi’s decision on LJ’s future.
Wednesday, June 19, 2024 - Episode 253: Jacobeth is ensnared in deceit. Evelyn is stressed over Toby’s case, and Letetswe reveals shocking academic results.
Thursday, June 20, 2024 - Episode 254: Elizabeth learns Jacobeth is in Mpumalanga. Kganyago's past is exposed, and Lehasa discovers his son is in KZN.
Friday, June 21, 2024 - Episode 255: Elizabeth confirms Jacobeth’s dubious activities in Mpumalanga. Rathebe lies about her relationship with Bullet, and Jacobeth faces theft accusations.
Monday, June 24, 2024 - Episode 256: Rathebe spies on Kganyago. Lehasa plans to retrieve his son from KZN, fearing what awaits.
Tuesday, June 25, 2024 - Episode 257: MaNtuli fears for Kwaito’s safety in Mpumalanga. Mr. Kgomo and Melita reconcile.
Wednesday, June 26, 2024 - Episode 258: Kganyago makes a bold escape. Elizabeth receives a shocking message from Kwaito. Mrs. Khoza defends her husband against scam accusations.
Thursday, June 27, 2024 - Episode 259: Babeile's skillful arrest changes the game. Tbose and Kwaito face a hostage crisis.
Friday, June 28, 2024 - Episode 260: Two women face the reality of being scammed. Turf is rocked by breaking
Tom Selleck Net Worth: A Comprehensive Analysisgreendigital
Over several decades, Tom Selleck, a name synonymous with charisma. From his iconic role as Thomas Magnum in the television series "Magnum, P.I." to his enduring presence in "Blue Bloods," Selleck has captivated audiences with his versatility and charm. As a result, "Tom Selleck net worth" has become a topic of great interest among fans. and financial enthusiasts alike. This article delves deep into Tom Selleck's wealth, exploring his career, assets, endorsements. and business ventures that contribute to his impressive economic standing.
Follow us on: Pinterest
Early Life and Career Beginnings
The Foundation of Tom Selleck's Wealth
Born on January 29, 1945, in Detroit, Michigan, Tom Selleck grew up in Sherman Oaks, California. His journey towards building a large net worth began with humble origins. , Selleck pursued a business administration degree at the University of Southern California (USC) on a basketball scholarship. But, his interest shifted towards acting. leading him to study at the Hills Playhouse under Milton Katselas.
Minor roles in television and films marked Selleck's early career. He appeared in commercials and took on small parts in T.V. series such as "The Dating Game" and "Lancer." These initial steps, although modest. laid the groundwork for his future success and the growth of Tom Selleck net worth. Breakthrough with "Magnum, P.I."
The Role that Defined Tom Selleck's Career
Tom Selleck's breakthrough came with the role of Thomas Magnum in the CBS television series "Magnum, P.I." (1980-1988). This role made him a household name and boosted his net worth. The series' popularity resulted in Selleck earning large salaries. leading to financial stability and increased recognition in Hollywood.
"Magnum P.I." garnered high ratings and critical acclaim during its run. Selleck's portrayal of the charming and resourceful private investigator resonated with audiences. making him one of the most beloved television actors of the 1980s. The success of "Magnum P.I." played a pivotal role in shaping Tom Selleck net worth, establishing him as a major star.
Film Career and Diversification
Expanding Tom Selleck's Financial Portfolio
While "Magnum, P.I." was a cornerstone of Selleck's career, he did not limit himself to television. He ventured into films, further enhancing Tom Selleck net worth. His filmography includes notable movies such as "Three Men and a Baby" (1987). which became the highest-grossing film of the year, and its sequel, "Three Men and a Little Lady" (1990). These box office successes contributed to his wealth.
Selleck's versatility allowed him to transition between genres. from comedies like "Mr. Baseball" (1992) to westerns such as "Quigley Down Under" (1990). This diversification showcased his acting range. and provided many income streams, reinforcing Tom Selleck net worth.
Television Resurgence with "Blue Bloods"
Sustaining Wealth through Consistent Success
In 2010, Tom Selleck began starring as Frank Reagan i
Maximizing Your Streaming Experience with XCIPTV- Tips for 2024.pdfXtreame HDTV
In today’s digital age, streaming services have become an integral part of our entertainment lives. Among the myriad of options available, XCIPTV stands out as a premier choice for those seeking seamless, high-quality streaming. This comprehensive guide will delve into the features, benefits, and user experience of XCIPTV, illustrating why it is a top contender in the IPTV industry.
Panchayat Season 3 - Official Trailer.pdfSuleman Rana
The dearest series "Panchayat" is set to make a victorious return with its third season, and the fervor is discernible. The authority trailer, delivered on May 28, guarantees one more enamoring venture through the country heartland of India.
Jitendra Kumar keeps on sparkling as Abhishek Tripathi, the city-reared engineer who ends up functioning as the secretary of the Panchayat office in the curious town of Phulera. His nuanced depiction of a young fellow exploring the difficulties of country life while endeavoring to adjust to his new environmental factors has earned far and wide recognition.
Neena Gupta and Raghubir Yadav return as Manju Devi and Brij Bhushan Dubey, separately. Their dynamic science and immaculate acting rejuvenate the hardships of town administration. Gupta's depiction of the town Pradhan with an ever-evolving outlook, matched with Yadav's carefully prepared exhibition, adds profundity and credibility to the story.
New Difficulties and Experiences
The trailer indicates new difficulties anticipating the characters, as Abhishek keeps on wrestling with his part in the town and his yearnings for a superior future. The series has reliably offset humor with social editorial, and Season 3 looks ready to dig much more profound into the intricacies of rustic organization and self-awareness.
Watchers can hope to see a greater amount of the enchanting and particular residents who have become fan top picks. Their connections and the one of a kind cut of-life situations give a reviving and interesting portrayal of provincial India, featuring the two its appeal and its difficulties.
A Mix of Humor and Heart
One of the signs of "Panchayat" is its capacity to mix humor with sincere narrating. The trailer features minutes that guarantee to convey giggles, as well as scenes that pull at the heartstrings. This equilibrium has been a critical calculate the show's prosperity, resounding with crowds across different socioeconomics.
Creation Greatness
The creation quality remaining parts first rate, with the beautiful setting of Phulera town filling in as a scenery that upgrades the narrating. The meticulousness in portraying provincial life, joined with sharp composition and solid exhibitions, guarantees that "Panchayat" keeps on hanging out in the packed web series scene.
Expectation and Delivery
As the delivery date draws near, expectation for "Panchayat" Season 3 is at a record-breaking high. The authority trailer has previously created critical buzz, with fans enthusiastically anticipating the continuation of Abhishek Tripathi's excursion and the new undertakings that lie ahead in Phulera.
All in all, the authority trailer for "Panchayat" Season 3 recommends that watchers are in for another drawing in and engaging ride. Yet again with its charming characters, convincing story, and ideal mix of humor and show, the new season is set to enamor crowds. Write in your schedules and prepare to get back to the endearing universe of "Panchayat."
Are the X-Men Marvel or DC An In-Depth Exploration.pdfXtreame HDTV
The world of comic books is vast and filled with iconic characters, gripping storylines, and legendary rivalries. Among the most famous groups of superheroes are the X-Men. Created in the early 1960s, the X-Men have become a cultural phenomenon, featuring in comics, animated series, and blockbuster movies. A common question among newcomers to the comic book world is: Are the X-Men Marvel or DC? This article delves into the history, creators, and significant moments of the X-Men to provide a comprehensive answer.
Hollywood Actress - The 250 hottest galleryZsolt Nemeth
Hollywood Actress amazon album eminent worldwide media, female-singer, actresses, alhletina-woman, 250 collection.
Highest and photoreal-print exclusive testament PC collage.
Focused television virtuality crime, novel.
The sheer afterlife of the work is activism-like hollywood-actresses point com.
173 Illustrate, 250 gallery, 154 blog, 120 TV serie logo, 17 TV president logo, 183 active hyperlink.
HD AI face enhancement 384 page plus Bowker ISBN, Congress LLCL or US Copyright.
Meet Crazyjamjam - A TikTok Sensation | Blog EternalBlog Eternal
Crazyjamjam, the TikTok star everyone's talking about! Uncover her secrets to success, viral trends, and more in this exclusive feature on Blog Eternal.
Source: https://blogeternal.com/celebrity/crazyjamjam-leaks/
From the Editor's Desk: 115th Father's day Celebration - When we see Father's day in Hindu context, Nanda Baba is the most vivid figure which comes to the mind. Nanda Baba who was the foster father of Lord Krishna is known to provide love, care and affection to Lord Krishna and Balarama along with his wife Yashoda; Letter’s to the Editor: Mother's Day - Mother is a precious life for their children. Mother is life breath for her children. Mother's lap is the world happiness whose debt can never be paid.
Scandal! Teasers June 2024 on etv Forum.co.zaIsaac More
Monday, 3 June 2024
Episode 47
A friend is compelled to expose a manipulative scheme to prevent another from making a grave mistake. In a frantic bid to save Jojo, Phakamile agrees to a meeting that unbeknownst to her, will seal her fate.
Tuesday, 4 June 2024
Episode 48
A mother, with her son's best interests at heart, finds him unready to heed her advice. Motshabi finds herself in an unmanageable situation, sinking fast like in quicksand.
Wednesday, 5 June 2024
Episode 49
A woman fabricates a diabolical lie to cover up an indiscretion. Overwhelmed by guilt, she makes a spontaneous confession that could be devastating to another heart.
Thursday, 6 June 2024
Episode 50
Linda unwittingly discloses damning information. Nhlamulo and Vuvu try to guide their friend towards the right decision.
Friday, 7 June 2024
Episode 51
Jojo's life continues to spiral out of control. Dintle weaves a web of lies to conceal that she is not as successful as everyone believes.
Monday, 10 June 2024
Episode 52
A heated confrontation between lovers leads to a devastating admission of guilt. Dintle's desperation takes a new turn, leaving her with dwindling options.
Tuesday, 11 June 2024
Episode 53
Unable to resort to violence, Taps issues a verbal threat, leaving Mdala unsettled. A sister must explain her life choices to regain her brother's trust.
Wednesday, 12 June 2024
Episode 54
Winnie makes a very troubling discovery. Taps follows through on his threat, leaving a woman reeling. Layla, oblivious to the truth, offers an incentive.
Thursday, 13 June 2024
Episode 55
A nosy relative arrives just in time to thwart a man's fatal decision. Dintle manipulates Khanyi to tug at Mo's heartstrings and get what she wants.
Friday, 14 June 2024
Episode 56
Tlhogi is shocked by Mdala's reaction following the revelation of their indiscretion. Jojo is in disbelief when the punishment for his crime is revealed.
Monday, 17 June 2024
Episode 57
A woman reprimands another to stay in her lane, leading to a damning revelation. A man decides to leave his broken life behind.
Tuesday, 18 June 2024
Episode 58
Nhlamulo learns that due to his actions, his worst fears have come true. Caiphus' extravagant promises to suppliers get him into trouble with Ndu.
Wednesday, 19 June 2024
Episode 59
A woman manages to kill two birds with one stone. Business doom looms over Chillax. A sobering incident makes a woman realize how far she's fallen.
Thursday, 20 June 2024
Episode 60
Taps' offer to help Nhlamulo comes with hidden motives. Caiphus' new ideas for Chillax have MaHilda excited. A blast from the past recognizes Dintle, not for her newfound fame.
Friday, 21 June 2024
Episode 61
Taps is hungry for revenge and finds a rope to hang Mdala with. Chillax's new job opportunity elicits mixed reactions from the public. Roommates' initial meeting starts off on the wrong foot.
Monday, 24 June 2024
Episode 62
Taps seizes new information and recruits someone on the inside. Mary's new job
1. ACUTE POISONING
GUIDELINES FOR INITIAL
MANAGEMENT
Prof. Dr. Saad S Al Ani
Senior Pediatric Consultant
Head of Pediatric Department
Khorfakkan Hospital
Sharjah ,UAE
saadsalani@yahoo.com
2. INTRODUCTION
• The majority of poisonings are
accidental, especially in the under-5
age group
• Intentional overdoses and substance
abuse are seen in older children
http://emedicine.medscape.com/pediatrics_general/
6/30/2013 Acute poisoning Prof. Dr. Saad S Al Ani Khorfakkan Hospital
3. CONT.
• Deaths in children from poisoning are
becoming increasingly rare
• Factors responsible for this decline
include:
1. Introduction of child-resistant
containers
2. Reducing the pack sizes of aspirin and
acetaminophen
3. More effective management
http://emedicine.medscape.com/pediatrics_general/
6/30/2013 Acute poisoning Prof. Dr. Saad S Al Ani Khorfakkan Hospital
4. HOW CHILDREN DIFFER FROM ADULTS
• Pediatric patients may be particularly
vulnerable to certain toxins at specific
stages of childhood.
• Breast fed infants may be exposed to
drugs or toxins excreted in breast milk;
neonates have immature metabolic
capabilities
http://emedicine.medscape.com/pediatrics_general/
6/30/2013 Acute poisoning Prof. Dr. Saad S Al Ani Khorfakkan Hospital
5. CONT.
• Toddlers, as they develop exploratory
hand-to-mouth activity, may be
exposed to a wide range of potential
hazards
http://emedicine.medscape.com/pediatrics_general/
6/30/2013 Acute poisoning Prof. Dr. Saad S Al Ani Khorfakkan Hospital
6. GENERAL PRINCIPLES
Assess:
Type of ingestion (drug, preparation)
Time of incident
Amount of ingestion (include all medication
that was potentially in the bottle or packet
when calculating)
Weight of child
http://www.rch.org.au/clinicalguide/guideline_index/Acute_Poisoning_Guidelines_For_Initial_
Management/
6/30/2013 Acute poisoning Prof. Dr. Saad S Al Ani Khorfakkan Hospital
7. GENERAL PRINCIPLES
Cont.
Is the ingestion potentially harmful?
Beware of the possibility of mixed overdose
Beware of the possibility of inaccurate dose
reporting on history taking
If mixed or undetermined ingestion
Paracetamol level should be done
http://www.rch.org.au/clinicalguide/guideline_index/Acute_Poisoning_Guidelines_For_Initial_
Management/
6/30/2013 Acute poisoning Prof. Dr. Saad S Al Ani Khorfakkan Hospital
8. GENERAL PRINCIPLES
Management
Airway
Breathing
Circulation
Removal of poison (if necessary)
Emesis
No role in the hospital setting
http://www.rch.org.au/clinicalguide/guideline_index/Acute_Poisoning_Guidelines_For_Initial_
Management/
6/30/2013 Acute poisoning Prof. Dr. Saad S Al Ani Khorfakkan Hospital
9. GENERAL PRINCIPLES
Cont.
Activated Charcoal
The treatment of choice for most ingestions.
Most effective when given within first hour.
http://www.rch.org.au/clinicalguide/guideline_index/Acute_Poisoning_Guidelines_For_Initial_
Management/
6/30/2013 Acute poisoning Prof. Dr. Saad S Al Ani Khorfakkan Hospital
11. GENERAL PRINCIPLES
Cont.
Whole Bowel Irrigation has a limited role
in treatment of some slow release
preparations
Gastric Lavage has a very limited role in
treatment and should not be used without
consultation.
Specific antidotes may be available and
serum drug levels may help in treatment
decisions
http://www.rch.org.au/clinicalguide/guideline_index/Acute_Poisoning_Guidelines_For_Initial_
Management/
6/30/2013 Acute poisoning Prof. Dr. Saad S Al Ani Khorfakkan Hospital
12. GENERAL PRINCIPLES
Cont.
All acts of deliberate self harm must be
taken extremely seriously.
All intentional self poisonings in
adolescents require admission
If unexplained symptoms exist a urinary
drug screen may be indicated
http://www.rch.org.au/clinicalguide/guideline_index/Acute_Poisoning_Guidelines_For_Initial_
Management/
6/30/2013 Acute poisoning Prof. Dr. Saad S Al Ani Khorfakkan Hospital
13. INITIAL ASSESSMENT AND MANAGEMENT
The initial priority in treating poisoned
children is the standard ABC
(airway, breathing, and circulation)
resuscitation approach
http://emedicine.medscape.com/pediatrics_general/
6/30/2013 Acute poisoning Prof. Dr. Saad S Al Ani Khorfakkan Hospital
14. A: ASSESS AIRWAY PATENCY
By looking, listening, and feeling for
air movement.
If there is no air movement, try to open
the airway with simple maneuvers such
as the jaw thrust or the use of airway
adjuncts.
http://emedicine.medscape.com/pediatrics_general/
6/30/2013 Acute poisoning Prof. Dr. Saad S Al Ani Khorfakkan Hospital
15. CONT.
Certain ingested agents may predispose
to airway edema and
obstruction, including caustic
agents, angiotensin-converting enzyme
inhibitors, and plants containing
calcium oxalate crystals
(e.g. Dieffenbachia and
Philodendron house plants)
http://emedicine.medscape.com/pediatrics_general/
6/30/2013 Acute poisoning Prof. Dr. Saad S Al Ani Khorfakkan Hospital
16. B: ASSESS THE ADEQUACY OF BREATHING
It is important to remember that
succinylcholine may cause prolonged
block in children who have a reduced
cholinesterase concentration due to
exposure to cocaine or
organophosphate compounds:
prolonged apneas of up to 7 h have
been described.
http://emedicine.medscape.com/pediatrics_general/
6/30/2013 Acute poisoning Prof. Dr. Saad S Al Ani Khorfakkan Hospital
17. CONT.
Observing ventilatory frequency, use of
accessory muscles, breath sounds, and
oxygen saturations.
Reduced respiratory effort may require
bag-valve-mask ventilation until a
definitive airway can be secured
http://emedicine.medscape.com/pediatrics_general/
6/30/2013 Acute poisoning Prof. Dr. Saad S Al Ani Khorfakkan Hospital
18. C: ASSESS THE CIRCULATION
In terms of cardiovascular status (heart
rate, arterial pressure, and capillary
refill) and the effect of circulatory
inadequacy on other organs (mental
state, urine output, skin
temperature, and colour).
http://emedicine.medscape.com/pediatrics_general/
6/30/2013 Acute poisoning Prof. Dr. Saad S Al Ani Khorfakkan Hospital
19. CONT.
Hypotension should initially be treated
with a 20 ml/ kg crystalloid
bolus, remembering that if it is caused
by specific toxins such as β-
blockers, the specific antidote should
also be given, for example, glucagon
http://emedicine.medscape.com/pediatrics_general/
6/30/2013 Acute poisoning Prof. Dr. Saad S Al Ani Khorfakkan Hospital
20. CONT.
Arrhythmias associated with poisoning
are best treated by:
i. Correcting precipitating factors (e.g.
hyperkalaemia and acidosis)
ii. Administering the appropriate
antidote;
http://emedicine.medscape.com/pediatrics_general/
6/30/2013 Acute poisoning Prof. Dr. Saad S Al Ani Khorfakkan Hospital
21. CONT.
Children in cardiac arrest should be
treated according to standard guidelines
(e.g. The Advanced Cardiac Life
Support protocol), although it is
important to address the need for a
specific antidote, for example, sodium
bicarbonate for tricyclic antidepressant
(TCA) poisoning
http://emedicine.medscape.com/pediatrics_general/
6/30/2013 Acute poisoning Prof. Dr. Saad S Al Ani Khorfakkan Hospital
24. SALICYLATES POISONING
Cont.
• Initial respiratory alkalosis (may be
transient), followed by paradoxical
aciduria (pH <6), then metabolic
acidosis & Hypokalemia (± ongoing
respiratory alkalosis).
http://www.rch.org.au/clinicalguide/guideline_index/Acute_Poisoning_Guidelines_For_Initial_
Management/
6/30/2013 Acute poisoning Prof. Dr. Saad S Al Ani Khorfakkan Hospital
25. SALICYLATES POISONING
Patients Requiring Treatment
Acute ingestion ≥ 150mg/kg
All symptomatic patients
Ingestion of unknown quantity
http://www.rch.org.au/clinicalguide/guideline_index/Acute_Poisoning_Guidelines_For_Initial_
Management/
6/30/2013 Acute poisoning Prof. Dr. Saad S Al Ani Khorfakkan Hospital
26. SALICYLATES POISONING
Investigations
Serum salicylate level at presentation (on
patients requiring treatment), and 2 hrly if
symptomatic or enteric coated preparation.
(Need to call the RCH lab to get test run
urgently as it is sent to RMH for analysis)
Urea & electrolytes, creatinine, acid-
base, glucose
http://www.rch.org.au/clinicalguide/guideline_index/Acute_Poisoning_Guidelines_For_Initial_
Management/
6/30/2013 Acute poisoning Prof. Dr. Saad S Al Ani Khorfakkan Hospital
27. SALICYLATES POISONING
Management
Asymptomatic
Charcoal 1g/kg (if <1 hour since ingestion unless
enteric coated preparation)
Observe 6 hours & discharge if still asymptomatic
If enteric coated preparations, serial salicylate levels
(2 hourly)
Admit if levels have not plateaued at 6 hours post
ingestion
I.V. bicarbonate infusion 1mmol/kg/hr to correct any
acidosis (pH <7.3)
http://www.rch.org.au/clinicalguide/guideline_index/Acute_Poisoning_Guidelines_For_Initial_
Management/
6/30/2013 Acute poisoning Prof. Dr. Saad S Al Ani Khorfakkan Hospital
28. SALICYLATES POISONING
Cont.
Symptomatic
All symptomatic patients require urgent medical
assessment and investigations as above.
Charcoal 1g/kg unless altered conscious state
(protect airway first)
I.V. fluid resuscitation to correct dehydration (use
N. Saline)
http://www.rch.org.au/clinicalguide/guideline_index/Acute_Poisoning_Guidelines_For_Initial_
Management/
6/30/2013 Acute poisoning Prof. Dr. Saad S Al Ani Khorfakkan Hospital
29. SALICYLATES POISONING
Symptomatic (Cont.)
I.V. bicarbonate infusion 1mmol/kg/hr, after
initial slow bolus of 2mmol/kg, (keep urine pH
>7.5)
Potassium replacement as required
Worsening symptoms, convulsion, coma, contact
I.C.U. for respiratory support hemodialysis
Salicylate level >7mmol/l following an acute
poisoning contact I.C.U. for consideration of
hemodialysis.
http://www.rch.org.au/clinicalguide/guideline_index/Acute_Poisoning_Guidelines_For_Initial_
Management/
6/30/2013 Acute poisoning Prof. Dr. Saad S Al Ani Khorfakkan Hospital
31. PARACETAMOL POISONING
Patients Requiring Management
1. Acute ingestion of > 200 mg/kg
2. Ingestion of unknown quantity
3. Repeated supratherapeutic ingestion of
> 100mg/kg/day
http://www.rch.org.au/clinicalguide/guideline_index/Acute_Poisoning_Guidelines_For_Initial_
Management/
6/30/2013 Acute poisoning Prof. Dr. Saad S Al Ani Khorfakkan Hospital
32. PARACETAMOL POISONING
Assessment
Consider the possibility of co
ingestions, either accidental or deliberate
http://www.rch.org.au/clinicalguide/guideline_index/Acute_Poisoning_Guidelines_For_Initial_
Management/
6/30/2013 Acute poisoning Prof. Dr. Saad S Al Ani Khorfakkan Hospital
33. PARACETAMOL POISONING
Management
Activated charcoal is not useful in liquid
ingestions due to rapid absorption
Activated charcoal 1 g/kg may be considered
in a cooperative patient seen within 1 hour of
tablet or capsule ingestion.
Serum paracetamol level at (or as soon as
possible after) 4 hours post ingestion
determines the need for N-acetyl cysteine
(NAC) administration. (see nomogram)
http://www.rch.org.au/clinicalguide/guideline_index/Acute_Poisoning_Guidelines_For_Initial_
Management/
6/30/2013 Acute poisoning Prof. Dr. Saad S Al Ani Khorfakkan Hospital
34. PARACETAMOL POISONING
There is no benefit in measuring
paracetamol level earlier than 4 hours
It is safe to wait for the paracetamol level to
decide on the need for NAC in all cases that
present within 8 hours of ingestion.
http://www.rch.org.au/clinicalguide/guideline_index/Acute_Poisoning_Guidelines_For_Initial_
Management/
6/30/2013 Acute poisoning Prof. Dr. Saad S Al Ani Khorfakkan Hospital
35. PARACETAMOL POISONING
Cont.
Patients who present > 8 hours after a toxic
ingestion / symptoms of toxicity (RUQ pain or
tenderness, nausea, vomiting) should be
commenced on NAC immediately.
The decision to continue or cease NAC is then
based on the paracetamol level.
Delaying NAC administration beyond 8 hours is
associated with a progressive increased risk of
liver injury.
http://www.rch.org.au/clinicalguide/guideline_index/Acute_Poisoning_Guidelines_For_Initial_
Management/
6/30/2013 Acute poisoning Prof. Dr. Saad S Al Ani Khorfakkan Hospital
36. PARACETAMOL POISONING
There is little evidence to guide management
in repeated supratherapeutic doses. Potential
toxicity should be assessed when:
> 200 mg/kg (or 10g) ingested over a 24
hour period
> 150 mg/kg/day (or 6 g) ingested over a 48
hour period
> 100 mg/kg/day ingested over a 72 hour
period
http://www.rch.org.au/clinicalguide/guideline_index/Acute_Poisoning_Guidelines_For_Initial_
Management/
6/30/2013 Acute poisoning Prof. Dr. Saad S Al Ani Khorfakkan Hospital
40. PARACETAMOL POISONING
N- Acetyl cysteine (NAC) Infusion
Instructions
The standard administration of NAC is a 3
stage infusion giving a total dose of 300
mg/kg:
1. 150 mg/kg over the first hour
2. 50 mg/kg over the next 4 hours
3. 100mg/kg over the next 16 hours
http://www.rch.org.au/clinicalguide/guideline_index/Acute_Poisoning_Guidelines_For_Initial_
Management/
6/30/2013 Acute poisoning Prof. Dr. Saad S Al Ani Khorfakkan Hospital
41. PARACETAMOL POISONING
Cont.
For patients > 110 kg, calculate the dose based
on 110 kg body weight.
NAC may be diluted in 5% dextrose or 0.9%
saline (normal saline).
It can also be diluted in combination dextrose-
saline solutions not exceeding these
concentrations including 0.45% saline in 5%
dextrose, and 0.9% saline in 5% dextrose.
http://www.rch.org.au/clinicalguide/guideline_index/Acute_Poisoning_Guidelines_For_Initial_
Management/
6/30/2013 Acute poisoning Prof. Dr. Saad S Al Ani Khorfakkan Hospital
42. PARACETAMOL POISONING
For adolescent / adult:
1. 150 mg/kg in 250 or 500 ml over 1
hour
2. 50 mg/kg in 500 ml over 4 hours
3. 100 mg/kg in 1000 ml over 16 hours
http://www.rch.org.au/clinicalguide/guideline_index/Acute_Poisoning_Guidelines_For_Initial_
Management/
6/30/2013 Acute poisoning Prof. Dr. Saad S Al Ani Khorfakkan Hospital
44. IRON POISONING
Background
Iron is found in several different forms in
different medicines.
The important ingestion is the amount of
elemental iron not the iron salt.
http://www.rch.org.au/clinicalguide/guideline_index/Acute_Poisoning_Guidelines_For_Initial_
Management/
6/30/2013 Acute poisoning Prof. Dr. Saad S Al Ani Khorfakkan Hospital
47. ASSESSMENT
Patients Requiring Assessment
1. Ingestion of > 40 mg/kg elemental iron.
(approximately > ½ tablet/kg or 6.5 ml
syrup/kg)
2. Ingestion of an unknown quantity.
3. Any symptomatic patients
http://www.rch.org.au/clinicalguide/guideline_index/Acute_Poisoning_Guidelines_For_Initial_
Management/
6/30/2013 Acute poisoning Prof. Dr. Saad S Al Ani Khorfakkan Hospital
48. HISTORY AND EXAMINATION
Initial symptoms:
Usually occur within 20 minutes
Nausea, vomiting, diarrhea, abdominal
pain, hypotension, Hematemesis, fever
Gastrointestinal symptoms related to the corrosive
nature of iron may occur without systemic
toxicity, however any symptoms require iron levels.
Lack of symptoms within the first 6 hours makes
significant toxicity unlikely.
http://www.rch.org.au/clinicalguide/guideline_index/Acute_Poisoning_Guidelines_For_Initial_
Management/
6/30/2013 Acute poisoning Prof. Dr. Saad S Al Ani Khorfakkan Hospital
49. HISTORY AND EXAMINATION
Latent period:
There is often 6-24 hour latent period when
initial symptoms resolve, before overt
systemic toxicity
Thus improvement over this time may be a
result of improvement or deterioration
http://www.rch.org.au/clinicalguide/guideline_index/Acute_Poisoning_Guidelines_For_Initial_
Management/
6/30/2013 Acute poisoning Prof. Dr. Saad S Al Ani Khorfakkan Hospital
50. HISTORY AND EXAMINATION
Other symptoms:
Usually appear at 6-24 hours and last 12-24
Tachycardia, vasoconstriction, hypotension
and shock
Metabolic acidosis can occur.
These are related to fluid shifts from
intravascular to extravascular compartments
and cellular hypoxia
http://www.rch.org.au/clinicalguide/guideline_index/Acute_Poisoning_Guidelines_For_Initial_
Management/
6/30/2013 Acute poisoning Prof. Dr. Saad S Al Ani Khorfakkan Hospital
51. HISTORY AND EXAMINATION
Multiple organ failure:
Occurs 12-48 hours after ingestion
Particularly hepatic failure
http://www.rch.org.au/clinicalguide/guideline_index/Acute_Poisoning_Guidelines_For_Initial_
Management/
6/30/2013 Acute poisoning Prof. Dr. Saad S Al Ani Khorfakkan Hospital
52. Management
ABC
Supportive therapy to maintain adequate
blood pressure and electrolyte balance is
essential
I.V. fluid resuscitation 20 ml/kg
Potassium and glucose administration as
necessary.
http://www.rch.org.au/clinicalguide/guideline_index/Acute_Poisoning_Guidelines_For_Initial_
Management/
6/30/2013 Acute poisoning Prof. Dr. Saad S Al Ani Khorfakkan Hospital
IRON POISONING
53. Investigations
Asymptomatic patients:
If tablet ingestion do AXR and if negative -
does not need further investigation or
observation
If unknown amount or >60mg/kg ingested
need serum iron levels 4 hourly until falling
http://www.rch.org.au/clinicalguide/guideline_index/Acute_Poisoning_Guidelines_For_Initial_
Management/
6/30/2013 Acute poisoning Prof. Dr. Saad S Al Ani Khorfakkan Hospital
IRON POISONING
54. All symptomatic patients should have the
following investigations:
AXR if tablet ingestion
ABG/CBG (acidosis)
Glucose (hyperglycaemia)
http://www.rch.org.au/clinicalguide/guideline_index/Acute_Poisoning_Guidelines_For_Initial_
Management/
6/30/2013 Acute poisoning Prof. Dr. Saad S Al Ani Khorfakkan Hospital
IRON POISONING
55. Cont.
Serum iron
Peak levels are usually seen at 4 hours.
Levels taken after four hours may underestimate
toxicity because the subject iron may have either been
distributed into tissues or be bound to ferritin.
In the case of slow release or enteric coated
tablets, levels should be repeated at six to eight hours as
absorption may be erratic.
Once desferroxamine is commenced, iron levels are not
accurate at most labs using automated methods
(including RCH)
http://www.rch.org.au/clinicalguide/guideline_index/Acute_Poisoning_Guidelines_For_Initial_
Management/
6/30/2013 Acute poisoning Prof. Dr. Saad S Al Ani Khorfakkan Hospital
IRON POISONING
56. Cont.
FBE (leukocytosis)
U&E & Cr
X-match
Clotting (reversible early coagulopathy and late
coagulopathy secondary to hepatic injury)
LFTs
AXR may be helpful in evaluating gastrointestinal
decontamination after treatment if tablets have been
ingested.
http://www.rch.org.au/clinicalguide/guideline_index/Acute_Poisoning_Guidelines_For_Initial_
Management/
6/30/2013 Acute poisoning Prof. Dr. Saad S Al Ani Khorfakkan Hospital
IRON POISONING
57. Cont.
Decontamination
Charcoal is of no benefit.
Decontamination of choice is whole bowel irrigation
(WBI) with naso-gastric colonic lavage solution
30ml/kg/hr until rectal effluent clear (contraindicated if
there are signs of bowel obstruction or haemorrhage).
WBI is indicated:
If AXR reveals tablets, or capsules ingested
In symptomatic patients
http://www.rch.org.au/clinicalguide/guideline_index/Acute_Poisoning_Guidelines_For_Initial_
Management/
6/30/2013 Acute poisoning Prof. Dr. Saad S Al Ani Khorfakkan Hospital
IRON POISONING
58. Antidote:
Desferroxamine is a chelating agent which
forms a water soluble desferroxamine-iron
complex.
http://www.rch.org.au/clinicalguide/guideline_index/Acute_Poisoning_Guidelines_For_Initial_
Management/
6/30/2013 Acute poisoning Prof. Dr. Saad S Al Ani Khorfakkan Hospital
IRON POISONING
59. Consider desferroxamine in:
Serum iron levels > 90 micromol/l
Level 60 - 90 micromol/l and tablets visible on
XRay or symptomatic
(nausea, vomiting, diarrhea, abdominal
pain, haematemesis, fever)
Any patient with significant symptoms of altered
conscious
state, hypotension, tachycardia, tachypnea, or
worsening symptoms irrespective of ingested dose
or serum iron level.
Do not wait for iron level if altered conscious
state, shock, severe acidosis (pH <7.1), or
worsening symptoms but commence
Desferroxamine without delay.
http://www.rch.org.au/clinicalguide/guideline_index/Acute_Poisoning_Guidelines_For_Initial_
Management/
6/30/2013 Acute poisoning Prof. Dr. Saad S Al Ani Khorfakkan Hospital
IRON POISONING
60. Dose: Desferroxamine 15 mg/kg/hr I.V. The rate
is reduced after four to six hours so that the total
intravenous dose in general does not exceed 80
mg/kg/24 hours.
Desferroxamine -iron complex is renally excreted.
If oliguria or anuria develop, peritoneal dialysis
or hemodialysis may become necessary to remove
ferrioxamine.
http://www.rch.org.au/clinicalguide/guideline_index/Acute_Poisoning_Guidelines_For_Initial_
Management/
6/30/2013 Acute poisoning Prof. Dr. Saad S Al Ani Khorfakkan Hospital
IRON POISONING
61. It is difficult to determine the endpoint for
chelation therapy.
Significant poisoning usually requires 12 -
16 hours,
http://www.rch.org.au/clinicalguide/guideline_index/Acute_Poisoning_Guidelines_For_Initial_
Management/
6/30/2013 Acute poisoning Prof. Dr. Saad S Al Ani Khorfakkan Hospital
IRON POISONING
62. Cont.
It is recommended to continue desferroxamine
until:
Patient is asymptomatic.
decontamination complete
anion-gap acidosis resolved
Iron level (if measurable) is <54 micromol/L
Desferroxamine has been associated with
pulmonary toxicity and should be used with
caution if indications persist >24 hours.
http://www.rch.org.au/clinicalguide/guideline_index/Acute_Poisoning_Guidelines_For_Initial_
Management/
6/30/2013 Acute poisoning Prof. Dr. Saad S Al Ani Khorfakkan Hospital
IRON POISONING
64. Hydrocarbons Include:
Petrol
Kerosene
Lighter Fluid
Mineral Turpentine
Paraffin Oil
Lubricating Oil
Furniture Polishes
2 Stroke Fuel
Diesel Fuel
White Spirit
http://www.rch.org.au/clinicalguide/guideline_index/Acute_Poisoning_Guidelines_For_Initial_
Management/
6/30/2013 Acute poisoning Prof. Dr. Saad S Al Ani Khorfakkan Hospital
HYDROCARBON POISONING
65. Assessment
Main complication is Aspiration Pneumonitis
C.N.S. toxicity can be evident (either depression or
excitement)
http://www.rch.org.au/clinicalguide/guideline_index/Acute_Poisoning_Guidelines_For_Initial_
Management/
6/30/2013 Acute poisoning Prof. Dr. Saad S Al Ani Khorfakkan Hospital
HYDROCARBON POISONING
66. Symptoms:
Coughing, choking, respiratory distress
ataxia, drowsiness, coma, convulsions
persistent burping (particularly seen after
petrol ingestion
http://www.rch.org.au/clinicalguide/guideline_index/Acute_Poisoning_Guidelines_For_Initial_
Management/
6/30/2013 Acute poisoning Prof. Dr. Saad S Al Ani Khorfakkan Hospital
HYDROCARBON POISONING
67. Keep nil orally charcoal is contraindicated.
Asymptomatic
Observe 6hours
Discharge if remains asymptomatic
Arrange review by LMO the following day
http://www.rch.org.au/clinicalguide/guideline_index/Acute_Poisoning_Guidelines_For_Initial_
Management/
6/30/2013 Acute poisoning Prof. Dr. Saad S Al Ani Khorfakkan Hospital
MANAGEMENT
68. Symptomatic
If develops respiratory symptoms
(aspiration), do CXR & O2 saturation
Give O2 to maintain saturation > 94%
If stable, admit to general medical ward
If increasing O2 requirements or increased
respiratory distress contact I.C.U.
If altered conscious state at any time contact
I.C.U.
http://www.rch.org.au/clinicalguide/guideline_index/Acute_Poisoning_Guidelines_For_Initial_
Management/
6/30/2013 Acute poisoning Prof. Dr. Saad S Al Ani Khorfakkan Hospital
MANAGEMENT (CONT.)
70. Alkalis include:
Drain cleaners, Oven cleaners
Automatic dish washing liquids & powders
Laundry detergents, Ammonia
Portland cement
http://www.rch.org.au/clinicalguide/guideline_index/Acute_Poisoning_Guidelines_For_Initial_
Management/
6/30/2013 Acute poisoning Prof. Dr. Saad S Al Ani Khorfakkan Hospital
ALKALIS POISONING
71. pH of >11.5 is likely to cause significant GI
ulceration
Attempt to obtain container to check
contents and strength of substance.
http://www.rch.org.au/clinicalguide/guideline_index/Acute_Poisoning_Guidelines_For_Initial_
Management/
6/30/2013 Acute poisoning Prof. Dr. Saad S Al Ani Khorfakkan Hospital
ALKALIS POISONING
72. Corrosive potential varies with concentration of
specific ingredients and preparations, ie liquid
preparations are more likely to cause esophageal
burns than powders.
Check preparations with Poisons Information Centre
to determine whether ingested substance is
weak, strong, irritant or corrosive in nature.
http://www.rch.org.au/clinicalguide/guideline_index/Acute_Poisoning_Guidelines_For_Initial_
Management/
6/30/2013 Acute poisoning Prof. Dr. Saad S Al Ani Khorfakkan Hospital
ALKALIS POISONING(CONT.)
73. Toxicity
Exposure may lead to severe burns of
GIT, especially esophagus
Absence of mouth or pharyngeal ulcers does
not preclude gastro- oesophageal lesions
Symptoms: May be minimal
Pain
Nausea & vomiting, drooling or refusing to eat
and drink
Stridor, respiratory distress
http://www.rch.org.au/clinicalguide/guideline_index/Acute_Poisoning_Guidelines_For_Initial_
Management/
6/30/2013 Acute poisoning Prof. Dr. Saad S Al Ani Khorfakkan Hospital
ASSESSMENT
74. Activated charcoal is contraindicated
If asymptomatic treat with fluid dilution:
10ml/kg of water (max 250ml)
If asymptomatic after 4 hours and able to
eat and drink the patient can be safely
discharged
If any symptoms, contact surgical
registrar, & admit for oesophagoscopy
http://www.rch.org.au/clinicalguide/guideline_index/Acute_Poisoning_Guidelines_For_Initial_
Management/
6/30/2013 Acute poisoning Prof. Dr. Saad S Al Ani Khorfakkan Hospital
MANAGEMENT
76. CARBAMAZEPINE, PHENYTOIN, SODIUM
VALPROATE, PHENOBARBITONE
Assessment
CNS
Ataxia, drowsiness, coma, convulsions
GIT
Nausea & Vomiting
CVS
Hypotension, Arrhythmias
Drug levels are available for some anticonvulsants e.g.
carbamazepine, phenytoin, phenobarbitone
http://www.rch.org.au/clinicalguide/guideline_index/Acute_Poisoning_Guidelines_For_Initial_
Management/
6/30/2013 Acute poisoning Prof. Dr. Saad S Al Ani Khorfakkan Hospital
ANTICONVULSANT POISONING
77. All symptomatic patients
Acute ingestion of unknown quantity
Carbamazepine ingestion of >20mg/kg (for
patients not on maintenance treatment) or
the greater of more than twice the daily
dose or 20mg/kg for patients on
maintenance treatment
http://www.rch.org.au/clinicalguide/guideline_index/Acute_Poisoning_Guidelines_For_Initial_
Management/
6/30/2013 Acute poisoning Prof. Dr. Saad S Al Ani Khorfakkan Hospital
PATIENTS REQUIRING TREATMENT
78. Charcoal 1g/kg unless altered conscious state (protect
airway first)
Mild symptoms (e.g. ataxia, blurred vision)
observe 4 hours, discharge if symptom free
Moderate or persistent symptoms (after 4 hours of
observation)
Admit for observation
Severe symptoms
Depressed conscious state or cardiac arrhythmias
contact I.C.U. .
http://www.rch.org.au/clinicalguide/guideline_index/Acute_Poisoning_Guidelines_For_Initial_
Management/
6/30/2013 Acute poisoning Prof. Dr. Saad S Al Ani Khorfakkan Hospital
MANAGEMENT
81. Charcoal 1g/kg unless altered conscious state (protect
airway first)
Require ECG, cardiac monitoring
Asymptomatic: observe for 6 hours post ingestion and
discharge if have a normal ECG just prior to discharge
All symptomatic patients should be admitted
If widened QRS on ECG commence Sodium Bicarbonate
infusion 1mmol/kg/hr, after initial slow bolus of 2mmol/kg
If altered conscious state, widened QRS or arrhythmia
contact I.C.U. & protect airway
http://www.rch.org.au/clinicalguide/guideline_index/Acute_Poisoning_Guidelines_For_Initial_
Management/
6/30/2013 Acute poisoning Prof. Dr. Saad S Al Ani Khorfakkan Hospital
MANAGEMENT
82. Assessment
Symptoms
CNS depression, drowsiness, coma
Respiratory depression
Hypotension
Beware additive toxicity with other CNS &
Respiratory depressants
http://www.rch.org.au/clinicalguide/guideline_index/Acute_Poisoning_Guidelines_For_Initial_
Management/
6/30/2013 Acute poisoning Prof. Dr. Saad S Al Ani Khorfakkan Hospital
BENZODIAZEPINE POISONING
83. Ingestion of ≥3 times recommended dose
for age
All symptomatic patients
Ingestion of unknown quantity
http://www.rch.org.au/clinicalguide/guideline_index/Acute_Poisoning_Guidelines_For_Initial_
Management/
6/30/2013 Acute poisoning Prof. Dr. Saad S Al Ani Khorfakkan Hospital
PATIENTS REQUIRING OBSERVATION
84. Charcoal is not usually of benefit (due to
low order of toxicity)
If depressed state of consciousness, protect
airway and contact ICU
Antidote available - Flumazenil, not
indicated for ingestions and should only be
used after discussion with consultant staff.
http://www.rch.org.au/clinicalguide/guideline_index/Acute_Poisoning_Guidelines_For_Initial_
Management/
6/30/2013 Acute poisoning Prof. Dr. Saad S Al Ani Khorfakkan Hospital
MANAGEMENT
86. Assessment
CNS
Agitation, hyperventilation, headache, convu
lsions
Cardiovascular
Arrhythmias
GIT
nausea & vomiting (may be
intractable), thirst, diarrhea
http://www.rch.org.au/clinicalguide/guideline_index/Acute_Poisoning_Guidelines_For_Initial_
Management/
6/30/2013 Acute poisoning Prof. Dr. Saad S Al Ani Khorfakkan Hospital
THEOPHYLLINE POISONING
87. Acute ingestion of ≥ 10mg/kg
Any ingestion while on maintenance
theophylline
Ingestion of unknown quantity
All symptomatic patients
http://www.rch.org.au/clinicalguide/guideline_index/Acute_Poisoning_Guidelines_For_Initial_
Management/
6/30/2013 Acute poisoning Prof. Dr. Saad S Al Ani Khorfakkan Hospital
PATIENTS REQUIRING TREATMENT
88. Theophylline levels should be determined on all patients
requiring charcoal
Serial levels are required at 2 hours then every 2 hours
until peak reached or decline demonstrated.
If slow release preparation has been taken:
admit, continue levels at 4 hourly intervals after decline or
plateau to ensure detection of secondary peak
Seizures are common at levels >330 micromol/L
Haemoperfusion commonly needed at levels > 550
micromol/L.
U&E, Cr and Glucose on all patients.
http://www.rch.org.au/clinicalguide/guideline_index/Acute_Poisoning_Guidelines_For_Initial_
Management/
6/30/2013 Acute poisoning Prof. Dr. Saad S Al Ani Khorfakkan Hospital
INVESTIGATIONS
89. Asymptomatic
Charcoal 1g/kg
Observe 4 hours. If no
symptoms, discharge if not slow release
medication.
If ingestion of slow release
preparation, admit for observation and
serial drug levelshttp://www.rch.org.au/clinicalguide/guideline_index/Acute_Poisoning_Guidelines_For_Initial_
Management/
6/30/2013 Acute poisoning Prof. Dr. Saad S Al Ani Khorfakkan Hospital
MANAGEMENT
90. Symptomatic
Charcoal 1g/kg initially unless altered conscious state
(protect airway first) then 0.5g/kg 4 hourly, and whole
bowel irrigation with colonic lavage solution 30ml/kg/hr.
Cardiac monitoring
I.V. fluid resuscitation & maintenance of adequate hydration
is vital
If depressed conscious state, arrhythmias or intractable
vomiting contact I.C.U. as likely to need intubation
Severe intoxication may require haemoperfusion
If agitated, may need sedation with a benzodiazepine or
phenobarbitone.
http://www.rch.org.au/clinicalguide/guideline_index/Acute_Poisoning_Guidelines_For_Initial_
Management/
6/30/2013 Acute poisoning Prof. Dr. Saad S Al Ani Khorfakkan Hospital
MANAGEMENT(CONT.)
93. Fatalities generally occur with blood levels > 86.8mmol/L
(breath alcohol >0.4)
Assessment
Symptoms
Nausea, vomiting, abdominal pain
Hypoglycemia
Ataxia, lethargy, coma, convulsions
Respiratory depression
http://www.rch.org.au/clinicalguide/guideline_index/Acute_Poisoning_Guidelines_For_Initial_
Management/
6/30/2013 Acute poisoning Prof. Dr. Saad S Al Ani Khorfakkan Hospital
ETHANOL POISONING
94. Hypothermia
Hypokalemia, metabolic acidosis
Unexplained drowsiness, hypothermia or hypoglycemia in
adolescents may be ethanol induced. In adolescents ethanol
ingestion often accompanies ingestion of other drugs.
Patients Requiring Treatment
symptomatic patients
http://www.rch.org.au/clinicalguide/guideline_index/Acute_Poisoning_Guidelines_For_Initial_
Management/
6/30/2013 Acute poisoning Prof. Dr. Saad S Al Ani Khorfakkan Hospital
ETHANOL POISONING(CONT.)
95. Charcoal is of no benefit
Check blood glucose in younger children
Asymptomatic or Mild Symptoms (decreased
inhibition, slight incoordination)
Observe for 2 hours
Give frequent carbohydrate containing drinks
Breath alcohol if possible
If remains symptomatic or symptoms worsen
admit
http://www.rch.org.au/clinicalguide/guideline_index/Acute_Poisoning_Guidelines_For_Initial_
Management/
6/30/2013 Acute poisoning Prof. Dr. Saad S Al Ani Khorfakkan Hospital
MANAGEMENT
96. Symptomatic (more than just mild symptoms or
continued symptoms after 2 hours)
Blood ethanol measurement, U& E, Glucose
I.V. fluid
Temperature regulation
Admit.
If unconscious or convulsions contact I.C.U.
http://www.rch.org.au/clinicalguide/guideline_index/Acute_Poisoning_Guidelines_For_Initial_
Management/
6/30/2013 Acute poisoning Prof. Dr. Saad S Al Ani Khorfakkan Hospital
MANAGEMENT(CONT.)
97. American Association of Poison Control Centers:
http://www.aapcc.org/dnn/Home.aspx
American Academy of Clinical Toxicology:
http://www.clintox.org/index.cfm
Centers for Disease Control and Prevention,
Section on Environmental health:
http://www.cdc.gov/Environmental
http://www.rch.org.au/clinicalguide/guideline_index/Acute_Poisoning_Guidelines_For_Initial_
Management/
6/30/2013 Acute poisoning Prof. Dr. Saad S Al Ani Khorfakkan Hospital
REFERENCES