Poisoning occurs when a substance interferes with normal body functions after being ingested, inhaled, injected or absorbed. Pre-hospital management of poisoning involves suspecting poisoning based on symptoms, calling for help if unconscious or having trouble breathing, and giving charcoal or egg whites depending on the poison. At the hospital, doctors check airway, breathing, and circulation, perform gastric lavage if appropriate, administer activated charcoal or whole bowel irrigation, and give antidotes if available. General supportive treatment addresses symptoms, and psychiatric counseling is important for suicidal poisonings.

1. GENERAL MANAGEMENT OF
POISONING
Definition:
Poisoning occurs when any substance interferes with normal body functions after it is
swallowed, inhaled, injected or absorbed. Drug overdoses occur when pharmacologic
preparations are taken in excess and lead to toxicity.
PRE-HOSPITAL MANAGEMENT
Suspect poisoning in the following conditions
Unexplained loss of consciousness or altered sensorium
Vomiting, difficulty breathing, sleepiness, confusion or other unexpected signs
Burns or redness around the mouth and lips, which can result from drinking
certain poisons
Breath that smells like chemicals, such as kerosene, insecticides or any unusual
smell
Burns, stains and odors on the person, or clothing or on the furniture, floor or
other objects in the surrounding area
Empty medication bottles or scattered pills
When to call for help
Call the local emergency medical service immediately if the person is:
Drowsy or unconscious
Having difficulty breathing or has stopped breathing
Having seizures
What to do while waiting for help
If the person is conscious and you are sure that he
has not taken kerosene or petroleum products, corrosives
or heavy metals, give charcoal slurry (homemade charcoal
–burnt toast mixed with tea).
If the patient has taken corrosives, egg white can
be safely administered. Homemade antidote
If the patient is unresponsive, open the airway and look for signs of breathing. If
no breathing is present, deliver artificial breathing only in the presence of barrier
devices or ambu-bag and check for signs of circulation (carotid pulse if you are a
doctor/paramedic and cough/limb movements for non-medical personnel).
Start CPR if there are no signs of circulation. If the victim is breathing, put the
patient in recovery position (lateral position) and reassess every 2 minutes.

2. If the person starts having convulsions, give convulsion first aid:
1. Protect the person from injury. Try to prevent a fall.
Lay the person on the ground in a safe area. Clear the area
of furniture or other sharp objects. .Cushion the person's
head. Loosen tight clothing, especially around the person's
neck. Turn the person on his or her side. If vomiting occurs,
this helps make sure that the vomit is not inhaled into the
lungs. Stay with the person until recovery or until you have
professional medical help. CPR
2. Do Not:
➢ DO NOT restrain the person.
➢ DO NOT place anything between the person's teeth during a seizure
(including your fingers).
➢ DO NOT move the person unless he or she is in danger or near
something hazardous.
➢ DO NOT try to make the person stop convulsing. He or she has no
control over the seizure and is not aware of what is happening at the time.
➢ DO NOT give the person anything by mouth until the convulsions
have stopped and the person is fully awake and alert.
If the suspected poison is a household cleaner or other chemical, read the label
and follow instructions for accidental poisoning.
If the person vomits, clear the person's airway. Wrap a cloth around your fingers
before cleaning out the mouth and throat. If the person has been sick from a plant part,
save the vomit. It may help experts identify what medicine can be used to help reverse
the poisoning.
Follow treatment directions that are given by the local emergency medical service.
If the poison is spilled on the person's clothing, skin or eyes, remove the clothing.
Flush the skin or eyes with cool or lukewarm water, such as by using a shower for 20
minutes or until help arrives.
Take the poison container (or any pill bottles) with you to the hospital.
For inhalation poisoning:
1. Call for emergency help. Never
attempt to rescue a person without
notifying others first.
2. If it is safe to do so, rescue the
person from the danger of the gas,
fumes, or smoke. Open windows and doors
to remove the fumes. Recovery Position
3. Take several deep breaths of fresh air, and then hold your
breath as you go in. Hold a wet cloth over your nose and mouth.

3. 4. When you want to rescue the person from a smoky area, crawl on
your knees and pull the patient to avoid inhalation of the smoke/fumes.
5. If in cardiac arrest, begin rescue breathing and CPR.
6. If necessary, perform first aid for eye injuries or convulsions.
7. Even if the person seems perfectly fine, get medical help.
What NOT to do while waiting for help
DO NOT administer ipecac syrup or do anything to induce vomiting.
DO NOT give charcoal if the patient is drowsy, unconscious or in poisoning with
corrosives/petroleum products.
DO NOT attempt mouth to mouth breathing if you suspect dangerous poisoning.
DO NOT go in to dangerous places without safety precautions.
DO NOT give an unconscious victim anything by mouth.
DO NOT try to neutralize the poison with lemon juice or vinegar, or any other
substance, unless you are told to do so by the emergency services.
DO NOT wait for symptoms to develop if you suspect that someone has been
poisoned.
HOSPITAL MANAGEMENT
Check Airway, Breathing, Circulation
• Airway
Check airway for patency and if in doubt, intubate the
patient.
• Breathing
If inadequate or absent respiratory rate, intubate the
patient and provide appropriate ventilatory support.
• Circulation
If inadequate blood pressure/hear rate, administer IV
fluids/vasopressors as appropriate. Intubation in suspected
poisonings with trauma
Gastric Lavage
With the patient in the left lateral and head-down position, pass the gastric lavage tube
up to the pre-measured marking and lavage the stomach with 200-250 ml of water
repeatedly until the lavaged solution is clear.
Contraindications to gastric lavage
Corrosive/petroleum products poisoning.
Caution: In drowsy or unconscious patient, INTUBATE before you attempt gastric
lavage.

4. Once the poison has moved past the stomach, other methods are needed:
Activated charcoal acts as a "super" absorber of many poisons. Once the poison
is stuck to the charcoal in the intestine, the poison cannot get absorbed into the
bloodstream. To be effective, activated charcoal needs to be given as soon as possible
after the poisoning. It does not work with alcohol, caustics, lithium, or petroleum
products.
Whole bowel irrigation requires drinking a large quantity of a fluid called Peglec. This
flushes the entire gastrointestinal tract before the poison gets absorbed.
Antidotes
Some poisons have specific antidotes. Antidotes either prevent the poison from working
or reverse the effects of the poison.
Antidotes to Common Poisons
Poison Antidote
Acetominophen NAC(N-acetylcysteine)
Anticholinergics Physostigmine
Anticoagulants
(warfarin/coumadin,heparin)
Vitamin K1, protamine.
Benzodiazepines Supportive Care, Flumazenil
Botulism Botulinum Antitoxin
Beta Blockers Glucagon
Calcium Channel Blockers Calcium, ?Glucagon?
Cholinergics
Atropine, Pralodixime in Organophosphate
Overdose
Carbon Monoxide Oxygen, Hyperbaric Oxygen
Cyanide
Amyl Nitrate, Sodium Nitrate, Sodium
Thiosulfate, Hydroxycobalamin
Digoxin Digoxin Fab Antibodies
Iron Deferoxamine
Isoniazid Pyridoxine
Lead BAL, EDTA, DMSA
Methemoglobinemia Methelene Blue

5. Opiods Naloxone
Toxic Alcohols
Ethanol Drip, Dialysis. Experimental trials
underway on Enzyme Inhibitors.
Tricyclic Antidepressants
Sodium Bicarbonate
It may also be possible to reverse the harmful effect of a drug even if no antidote
exists
➢ If a person with diabetes takes too much insulin, a dangerously low blood
sugar (hypoglycemia) will cause weakness, unconsciousness, and eventually death.
Sugar given by mouth or IV is an effective treatment until the insulin wears off.
➢ When the poison is a heavy metal, such as lead, special medicines
(chelators) bind the poison in the bloodstream and cause it to be eliminated in
the urine.
➢ Another "binder" is sodium polystyrene sulphonate (Kayexalate), which can
absorb potassium and other electrolytes from the bloodstream.
General supportive measures:
When there are no specific treatments, the physician will treat signs and symptoms as
needed.
➢ Sedatives to calm agitated or hallucinating patients until the drug wears
off.
➢ Intubation and ventilatory support for patients with inadequate or absent
breathing.
➢ Antiseizure medicines can be used to treat or prevent seizures.
➢ Appropriate fluid monitoring and management.
➢ Adequate nutrition and bed-sore prevention.
➢ Cardiac and pulmonary status monitoring.
Role of Psychiatry in Suicide Poisoning:
One must clearly understand that the above management would only treat the
complications of a psychiatric illness in suicidal poisonings and would not be complete
unless augmented with appropriate psychiatric counseling.

6. Opiods Naloxone
Toxic Alcohols
Ethanol Drip, Dialysis. Experimental trials
underway on Enzyme Inhibitors.
Tricyclic Antidepressants
Sodium Bicarbonate
It may also be possible to reverse the harmful effect of a drug even if no antidote
exists
➢ If a person with diabetes takes too much insulin, a dangerously low blood
sugar (hypoglycemia) will cause weakness, unconsciousness, and eventually death.
Sugar given by mouth or IV is an effective treatment until the insulin wears off.
➢ When the poison is a heavy metal, such as lead, special medicines
(chelators) bind the poison in the bloodstream and cause it to be eliminated in
the urine.
➢ Another "binder" is sodium polystyrene sulphonate (Kayexalate), which can
absorb potassium and other electrolytes from the bloodstream.
General supportive measures:
When there are no specific treatments, the physician will treat signs and symptoms as
needed.
➢ Sedatives to calm agitated or hallucinating patients until the drug wears
off.
➢ Intubation and ventilatory support for patients with inadequate or absent
breathing.
➢ Antiseizure medicines can be used to treat or prevent seizures.
➢ Appropriate fluid monitoring and management.
➢ Adequate nutrition and bed-sore prevention.
➢ Cardiac and pulmonary status monitoring.
Role of Psychiatry in Suicide Poisoning:
One must clearly understand that the above management would only treat the
complications of a psychiatric illness in suicidal poisonings and would not be complete
unless augmented with appropriate psychiatric counseling.