general management of toxicological cases
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general management of toxicological cases
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general management of toxicological cases
- 1. GENERAL APPROACH TO ACUTELY POISONED PATIENTS Prof. Enas El Taftazani Prof. of clinical toxicology
- 7. History Personal history History of present illness Past history Family history
- 10. Ask about : Respiratory symptoms:Cough,chest pain,dyspnea,,sputum GIT: N,V,diarhea,pain ch.ch. Of vomitus. Neurological: weakness,rigidity, CVS: palpitation ,chest pain,.dyspnea. Urinary: urine retention,…
- 12. Vital signs Pulse Temperature Blood pressure Respiratory rate
- 13. Pulse Bradycardia: Organophosphates,digoxin,opiate,barbiturates,B-blockers Tachycardia: Anticholinergics, sympathomimetics Irregular pulse: digoxin,TCA,sympathomimetics,CO
- 14. Blood pressure Hypotension: Decreased peripheral resistance Hypovolemia Decreased myocardial contractility Hypertension: Sympathomimetics Scorpion anticholinergics
- 15. Temperature Hyperthermia Salicylates Sympathomimetics Anticholinergics Antidepressents Hypothermia: CO,oral hypoglycemics Hypnotics ethanol
- 16. Respiratory rate Tachypnea: Hypoxia Acidosis With dyspnea as irritant gas Bradypnea : CNS depression,neuromuscular blockade
- 43. Antidotes (Cont’d) poison antidote Arsenic, mercury, lead Dimercaprol (BAL) Digoxin, digitoxin Digoxine immune Fab Iron Deferoxamine cyanide Cyanide kit CCB or hydrogen fluoride Ca gluconate or Ca chloride Carbamate or organophosphate atropine Crotalid snake bite Crotalid Antivenin acetaminophen acetylcysteine MeOH, et glycol ethanol TCA, cocaine, salicylates Sodium bicarbonate isoniazid pyridoxine organophosphate pralidoxime anticholinergic physostigmine opioids naloxone methemoglobin Methylene blue Β -blocker, CCB glucagon MeOH Fomepizole BDZ flumazenil poison antidote
- 57. CPR
Editor's Notes
- Failure to secure the airway is most lethal toxicological complication
- Location may be important for environmental or occupational exposures
- Brief, but detailed physical exam, hyperalert – look for anticholinergic toxidrome, big pupils AAAS, small pupils COPS, nystagmus –PCP, phenytoin GI – may alert to toxidrome or to contraindication to decon methods
- Numerous studies in both adult and pediatric populations demonstrate that tox screen does not contribute to management of pt
- Since we’re going to discuss the evidence behind the position statements at journal club, I will simply outline the recommendations
- Produced by pyrolysis of carbonaceous materials to incr surface area, first demonstrated in 1930 by touery who took several times lethal dose of strychnine in front of the Academie Francaise , chased it with charcoal and survived. A number of questions remain to be answered – charcoal vs. nothing, symptomatic patients presenting in first hour after ingestion,agents that slow gastric emptying, sustained release preps, massive or life threatening ingestions,what to do for caustic ingestions,
- Hemodialysis has been discussed, hemoperfusion is accomplished by running the venous blood through a charcoal hemoperfusion cartridge The advantage of hemodialysis over hemoperfusion is that HD can also correct met acidosis/alkalosis, hyperkalemia, and fluid overload
- Acidification of urine for weak bases was performed in the past, but not shown any benefit and causes met acidosis
- Atenolol is only b-blocker with low Vd
- If, after your history, physical and lab investigations – you’ve id’d a toxin – there may be a specific antidote There are approximately 18 antidotes commonly stocked in tertiary care centers in N. America