Poisoning can occur through inhalation, ingestion, injection or skin contact with harmful substances. Common causes of poisoning include accidental ingestion of cleaning agents, plants or chemicals by children, and chemical exposure for workers. Diagnostic tests may include toxicology studies of vomit, urine or blood to identify the poison, and imaging tests like chest xrays. Treatment involves emergency resuscitation, preventing further absorption using activated charcoal or gastric lavage, administration of antidotes, intravenous fluids and monitoring vital signs. Outcomes depend on the poison absorbed and speed of treatment.

1. Environmental Emergencies poisoning

2. Objectives Define poisoning correctly. Enumerate the causes of poisoning in children and adults. Describe the assessment findings and possible toxins that can cause signs & symptoms of poisoning. Discuss the diagnostic tests & treatments for poisoning.

3. Definition Inhalation, ingestion, and injection of, or skin contamination from, any harmful substance. Common environmental emergency. Prognosis depends on the amount of poison absorbed, its toxicity, and the time interval between poisoning and treatment.

4. causes

5. Children accident poisoning cleaning agents insecticides paints cosmetics plants

6. Adults Chemical company employee chlorine carbon dioxide hydrogen sulfide nitrogen dioxide ammonia Companies that ignore safety standards.

7. Adults Improper cooking Canning Storage of food Ingestion of or skin contamination from plants and accidental Intentional drug overdose or chemical ingestion

8. How it happens ?

12. assessment

13. The patient history should reveal the poison’s source and form of exposure. Assessment findings vary with the poison.

14. PINPOINTING POISON’S EFFECTS

30. Diagnostic tests

31. Toxicology studies Poison levels in the mouth Vomitus Urine Stool or blood, or on the victim’s hands or clothing, confirm the diagnosis. If possible, have the family or patient bring the container holding the poison to the ED for comparable study.

32. Chest X-ray Inhalation poisoning may show aspiration pneumonia. Petroleum distillate inhalation, they may show pulmonary infiltrates or edema. Abdominal x-rays may reveal iron pills or other radiopaque substances.

33. ABG analysis, Serum electrolyte levels & CBC Evaluate oxygenation, ventilation and the metabolic status of seriously poisoned patients.

34. What test tell you . . . Toxicology studies ( including drug screens) of poison levels in the mouth, vomitus, urine, stool or blood, or on the victim’s hands or clothing, confirm the diagnosis. If possible, have the family or patient bring the container holding the poison to the ED for comparable study. In inhalation poisoning chest X-rays may show aspiration pneumonia. In petroleum distillate inhalation, they may show pulmonary infiltrates or edema. Abdominal x-rays may reveal iron pills or other radiopaque substances. ABG analysis, serum electrolyte levels, and CBC are used to evaluate oxygenation, ventilation and the metabolic status of seriously poisoned patients.

35. TREATMENT

36. Initial treatment Emergency resuscitation Support of the patient’s ABCs and prevention further poison absorption

37. Secondary treatment Continuing supportive or symptomatic care and when possible administration of a specific antidote.

39. Poisoning victim Exhibits altered LOC routinely receives oxygen, glucose, and naloxone. Activated charcoal Effective in eliminating many toxic substances. Specific treatment depends on the poison.

40. Poisoning victim Carefully monitor the patient’s vital signs and LOC. If necessary, begin CPR.

41. Poisoning victim Prevent further absorption by administering activated charcoal, including emesis, or by administering gastric lavage and cathartics for specific treatment, contact the poison center. The treatment’s effectiveness depends on the speed of absorption and the time elapsed between ingestion and removal.

42. Emesis Never induce emesis if you suspect corrosive acid poisoning, if the patient is unconscious or has seizures or if the gag reflex is impaired, even in a conscious patient. Instead, neutralize the poison by instilling appropriate antidote by an NG tube. Common antidotes include milk, magnesium salts, activated charcoal, or other chelating agents, such as deferoxamine and edetate disodium.

43. Intravenous Therapy Use large quantities of I.V. fluids to force the poison through the kidneys to be excreted. Kind of fluid you use depends on the patient’s acid-base balance and cardiovascular status and on the flow rate necessary for effective diuresis of poison. If ingested poisoning severe and requires peritoneal dialysis or hemodialysis, assist as necessary.

44. Inhaled poison Prevent further absorption of inhaled poison, remove the patient to fresh or uncontaminated air. Provide supplemental oxygen and , if needed, intubation. Prevent further absorption from skin contamination, remove the clothing covering the contaminated skin and immediately flush the area with large amounts of water.

45. Inhaled poison If patient is in severe pain, give analgesics as ordered frequently monitor fluid intake and output, vital signs and LOC. Keep the patient warm and provide support in a quiet environment. If the poison was ingested intentionally, refer the patient for counseling to help prevent future attempts at suicide.

46. Reference Emergency Nursing made Incredibly Easy: Lippincott Williams & Wilkins, 2007

47. Thank you 