This document provides information on poisoning epidemiology and management. It notes that over 90% of toxic exposures occur in the home and most involve a single substance, with ingestion being the most common route. It describes the initial evaluation and treatment of patients, including decontamination procedures, supportive care, and administration of antidotes. Specific signs and symptoms of various types of poisonings and poison syndromes are also outlined. The document emphasizes the importance of supportive care, prevention of further poison absorption, and enhancement of poison elimination in management.
1. The document lists various symptoms that can indicate poisoning from different substances, including odor, sweating, changes in body temperature, delirium, convulsions, changes in pupil size, nystagmus, changes in heart rate, and respiratory changes.
2. It associates specific symptoms with different classes of toxic substances like organophosphates, salicylates, barbiturates, atropine, and opiates.
3. The table at the end shows how heart rate, temperature, pupil size, mucosa, and skin changes can help identify if a toxic exposure was adrenergic, anticholinergic, anticholinesterase, or opiod in nature.
This document discusses how social factors and modern diets influence food choices. Low-income groups have more limited and less nutritious diets due to cost, accessibility, and lack of knowledge barriers. They consume more energy-dense, nutrient-poor foods and develop health issues earlier. Modern diets consist of "junk foods" that are high in calories but low in nutrients. People's diets reflect the times and environments in which they live, with urbanization leading to increased risk of obesity and other chronic diseases. Addressing social needs is important to improving health inequalities related to diet.
Here are the answers to your questions:
1. Kvenland was an ancient name for the area in Scandinavia and Fennoscandia.
2. Christianization took place between the 8th and 12th centuries. Around 980, Harald Bluetooth Christianized Denmark. It began in Norway by Olaf Tryggvason 995 AD – 1000AD and Olaf Haraldsson 1015 AD – 1030 AD. Olof Skötkonung 980 -1022 began in Sweden.
3. If many of the foods of the area have a salty or smoky taste, or are pickled or dried, it’s largely because of winter and the need to preserve foods without refrigeration.
This document provides an overview of bronchial asthma. It discusses the definition, triggers, pathogenesis, epidemiology, risk factors, clinical features, differential diagnosis, investigations, classification of severity, and stepwise management approach. Some key points:
- Asthma is a chronic inflammatory airway disease characterized by paroxysmal dyspnea, wheeze and cough caused by airway hyperresponsiveness to triggers.
- Common triggers include indoor/outdoor allergens, air pollutants, exercise and emotions.
- Pathogenesis involves a type 1 hypersensitivity reaction leading to airway inflammation and remodeling.
- Prevalence is higher in females compared to males and in children compared to adults.
Cannabis: The Insider's Guide to The World's Most Popular Drug.Shadow Foundry
This document provides an overview of cannabis and its main components. It discusses the two main cannabis subspecies, Cannabis indica and Cannabis sativa, and explains that the main psychoactive component is delta-9-THC. It also covers the non-psychoactive component cannabidiol (CBD) and describes the endocannabinoid system that THC interacts with in the body. The document discusses consumption methods and their differing bioavailability, and provides safety guidelines and warnings for CBD usage.
Food allergy occurs when the immune system mistakenly identifies a food protein as harmful. Common types of food allergies include reactions to peanuts, tree nuts, eggs, milk, fish, and shellfish. Symptoms range from mild irritation to life-threatening anaphylaxis. Diagnosis involves skin prick tests, blood tests, or oral food challenges to identify IgE antibodies. Management focuses on strict avoidance of triggering foods, along with emergency medications like epinephrine for severe reactions. Proper food labeling and selection of non-allergenic foods can help prevent accidental exposures.
Killer B's, SLUDGE, and DUMBBELLSS are acronyms used to describe symptoms of cholinergic toxidromes caused by substances like carbamates and organophosphates. These symptoms include bradycardia, bronchospasm, salivation, lacrimation, urination, diarrhea, miosis, and seizures. Anti-cholinergic toxidromes are caused by substances like antihistamines and antidepressants and produce symptoms of delirium, mydriasis, fever, and urinary retention. Sympathomimetic toxidromes are seen with substances like cocaine and amphetamines and cause anxiety, tachycardia, sweating, and seizures.
This document discusses poisoning in children, including common causes, identification, and treatment approaches. It notes that children under 5 account for 80% of recorded poison ingestion cases. Identification involves obtaining a history, physical exam, and potentially analyzing samples. Toxidromes describing common symptoms of toxic exposures are outlined by system affected. Supportive care includes cardiopulmonary, fluid, hematologic, CNS, and renal support as needed. Decontamination involves gastric evacuation methods like ipecac or lavage, use of adsorbents like activated charcoal, and cathartics. Elimination can be enhanced through diuresis and extracorporeal removal. Specific antidotes are discussed for select poisons. The
1. The document lists various symptoms that can indicate poisoning from different substances, including odor, sweating, changes in body temperature, delirium, convulsions, changes in pupil size, nystagmus, changes in heart rate, and respiratory changes.
2. It associates specific symptoms with different classes of toxic substances like organophosphates, salicylates, barbiturates, atropine, and opiates.
3. The table at the end shows how heart rate, temperature, pupil size, mucosa, and skin changes can help identify if a toxic exposure was adrenergic, anticholinergic, anticholinesterase, or opiod in nature.
This document discusses how social factors and modern diets influence food choices. Low-income groups have more limited and less nutritious diets due to cost, accessibility, and lack of knowledge barriers. They consume more energy-dense, nutrient-poor foods and develop health issues earlier. Modern diets consist of "junk foods" that are high in calories but low in nutrients. People's diets reflect the times and environments in which they live, with urbanization leading to increased risk of obesity and other chronic diseases. Addressing social needs is important to improving health inequalities related to diet.
Here are the answers to your questions:
1. Kvenland was an ancient name for the area in Scandinavia and Fennoscandia.
2. Christianization took place between the 8th and 12th centuries. Around 980, Harald Bluetooth Christianized Denmark. It began in Norway by Olaf Tryggvason 995 AD – 1000AD and Olaf Haraldsson 1015 AD – 1030 AD. Olof Skötkonung 980 -1022 began in Sweden.
3. If many of the foods of the area have a salty or smoky taste, or are pickled or dried, it’s largely because of winter and the need to preserve foods without refrigeration.
This document provides an overview of bronchial asthma. It discusses the definition, triggers, pathogenesis, epidemiology, risk factors, clinical features, differential diagnosis, investigations, classification of severity, and stepwise management approach. Some key points:
- Asthma is a chronic inflammatory airway disease characterized by paroxysmal dyspnea, wheeze and cough caused by airway hyperresponsiveness to triggers.
- Common triggers include indoor/outdoor allergens, air pollutants, exercise and emotions.
- Pathogenesis involves a type 1 hypersensitivity reaction leading to airway inflammation and remodeling.
- Prevalence is higher in females compared to males and in children compared to adults.
Cannabis: The Insider's Guide to The World's Most Popular Drug.Shadow Foundry
This document provides an overview of cannabis and its main components. It discusses the two main cannabis subspecies, Cannabis indica and Cannabis sativa, and explains that the main psychoactive component is delta-9-THC. It also covers the non-psychoactive component cannabidiol (CBD) and describes the endocannabinoid system that THC interacts with in the body. The document discusses consumption methods and their differing bioavailability, and provides safety guidelines and warnings for CBD usage.
Food allergy occurs when the immune system mistakenly identifies a food protein as harmful. Common types of food allergies include reactions to peanuts, tree nuts, eggs, milk, fish, and shellfish. Symptoms range from mild irritation to life-threatening anaphylaxis. Diagnosis involves skin prick tests, blood tests, or oral food challenges to identify IgE antibodies. Management focuses on strict avoidance of triggering foods, along with emergency medications like epinephrine for severe reactions. Proper food labeling and selection of non-allergenic foods can help prevent accidental exposures.
Killer B's, SLUDGE, and DUMBBELLSS are acronyms used to describe symptoms of cholinergic toxidromes caused by substances like carbamates and organophosphates. These symptoms include bradycardia, bronchospasm, salivation, lacrimation, urination, diarrhea, miosis, and seizures. Anti-cholinergic toxidromes are caused by substances like antihistamines and antidepressants and produce symptoms of delirium, mydriasis, fever, and urinary retention. Sympathomimetic toxidromes are seen with substances like cocaine and amphetamines and cause anxiety, tachycardia, sweating, and seizures.
This document discusses poisoning in children, including common causes, identification, and treatment approaches. It notes that children under 5 account for 80% of recorded poison ingestion cases. Identification involves obtaining a history, physical exam, and potentially analyzing samples. Toxidromes describing common symptoms of toxic exposures are outlined by system affected. Supportive care includes cardiopulmonary, fluid, hematologic, CNS, and renal support as needed. Decontamination involves gastric evacuation methods like ipecac or lavage, use of adsorbents like activated charcoal, and cathartics. Elimination can be enhanced through diuresis and extracorporeal removal. Specific antidotes are discussed for select poisons. The
The document provides dietary recommendations for managing hypertensive disorders including following the DASH diet which focuses on fruits, vegetables, whole grains, lean proteins and low-fat dairy while limiting fats, cholesterol, and sodium. Foods high in nitric oxide like beetroot, garlic and leafy greens are recommended to help lower blood pressure. A sample diet plan emphasizes potassium-rich foods like bananas, oranges and spinach to support blood pressure control while limiting sodium to less than 1500mg per day.
This document provides information about counseling patients on inhalers and medications for asthma and COPD. It begins by defining asthma and COPD, and discussing the differences between the two conditions. It then covers the types of asthma and the goals and classes of treatment for asthma. Short-acting beta agonists like albuterol and long-acting beta agonists like salmeterol are described in detail, including dosages. Leukotriene inhibitors like montelukast are also outlined. Finally, inhaled corticosteroids like beclomethasone are discussed, including mechanisms of action, dosages, side effects and drug interactions.
The document discusses drug overdose poisoning and provides information on:
1. Drug overdose occurs when drugs are consumed in excessive amounts, either intentionally or unintentionally, and injure the body.
2. Drug overdose is a leading cause of injury death, especially among those aged 25-64. Opioids and benzodiazepines are commonly involved in overdoses.
3. Risk factors for overdose include being male, white, and between ages 45-49. Children under 15 have the lowest overdose rates.
This document discusses the cuisine of the United States by region. It outlines the historical influences on American cuisine from the pre-colonial, colonial and post-independence periods. Key dishes that are considered typically American include peanut butter, apple pie, eggs and bacon for breakfast, and hamburgers. The document then describes the regional cuisines of New England, the Mid-Atlantic, the South, the Midwest, the Southwest, the West, and Pacific/Hawaiian regions. Each region is known for certain signature ingredients and dishes that were shaped by their history and culture.
The document lists several common herbal medicines and their uses and cautions, including St. John's wort for depression which can interact with sulfonamide antibiotics, garlic for hypertension which should be avoided with aspirin, and ginger root for nausea which can interact with Coumadin. It provides information on potential benefits, drug interactions and cautions for each herbal medicine listed. The document serves as a reference for nurses on key herbal medicines and factors to consider when patients take them.
The document discusses neonatal pain, including that babies can feel and react to pain, validated scales exist to measure neonatal pain, and developmental aspects of pain perception in newborns. It also outlines non-pharmacological and pharmacological approaches to treating pain in newborns, emphasizing the need for comprehensive pain management strategies that minimize unnecessary pain in neonates.
The document provides tips for dealing with picky eaters. It recommends establishing regular meal and snack times to prevent kids from being hungry at meals. Parents should introduce one new food per week and be role models by eating healthy. The document advises against forcing kids to eat, rewarding eating with treats, and allowing distractions during meals. Parents are encouraged to introduce new foods multiple times and explain food groups' importance.
1) Hydrocarbon (such as kerosene) poisoning is common in children in developing countries due to unsafe storage practices. It can cause central nervous system depression, seizures, and chemical pneumonitis if aspirated.
2) Hydrocarbons are classified into aromatic, aliphatic, halogenated, and terpene compounds. Common sources of exposure include petrol, kerosene, and solvents.
3) Management involves resuscitation, intubation for respiratory support, treatment of seizures and dysrhythmias, and observation for 6 hours or more depending on symptoms. Activated charcoal is contraindicated. Outcomes are generally good if not aspirated, but chemical pneumonitis can
Breastfeeding provides ideal nutrition for infants and has numerous health benefits for both mother and baby. It gives babies antibodies and nutrients tailored for them. The document defines breastfeeding as the normal way to provide young infants with needed nutrients for growth. Breastfeeding is recommended exclusively for six months and continued along with complementary foods up to two years or longer. The anatomy and physiology of lactation are described, including milk production triggered by the baby's sucking. Advantages of breastfeeding include its availability, low cost, protection from infection, and psychological benefits. Contraindications for mothers and infants are outlined.
The document provides an overview of 10 top cuisines from around the world, including French, Indonesian, and Mexican cuisine. It describes French cuisine as using sauces, fresh herbs, seafood, poultry and meats, along with regional specialties. Indonesian cuisine is influenced by India, Spain, the Middle East, China, and Portugal, featuring rice, seafood, noodles, tempeh, and spices. Mexican cuisine originated from the Mayans and Aztecs and was later influenced by Spanish introduction of livestock, dairy, herbs, wheat, and spices.
The document discusses infant and child feeding, including breastfeeding, artificial feeding, and introducing solids. It describes the anatomy and physiology of breastfeeding, comparing breast milk to cow's milk. Guidelines are provided for breastfeeding techniques, determining milk supply, introducing formula or solids, and weaning from breastfeeding to solid foods.
The document discusses toxicology and poison control. It provides information on common toxic exposures including drugs, chemicals, plants and animals. Poison control centers provide treatment advice and education on poisonings. They are responsible for toxicology consultation, data collection, education and research. Early identification of poisoning is important for successful management. The majority of poisonings occur in the home and involve young children.
The document discusses the evaluation and management of pediatric toxic exposures and ingestions, including general principles, potentially toxic ingestions of 1-3 tablets, emergency management of airway, breathing, circulation and other systems, decontamination methods, specific toxic syndromes and antidotes, and case examples of ethanol and iron ingestions. Management involves stabilization, decontamination if indicated, treatment of specific toxic effects, and consideration of toxicology studies and antidotes based on the exposure.
This document provides information on acute poisoning, including definitions, common causes, general management approaches, and specific management for certain types of poisoning. It discusses paracetamol poisoning, organophosphorus insecticide poisoning, and opiate poisoning. For paracetamol poisoning, it outlines treatment with acetylcysteine or alternative treatments based on time since ingestion. For organophosphorus poisoning, it describes the triphasic illness and recommends atropine as the antidote. The document provides detailed guidance on assessment, monitoring, supportive care and specific treatments for acute poisoning.
This document discusses drug overdoses, including definitions, common drugs involved, risk factors, evaluation and treatment. It notes that overdoses can be intentional or accidental and are a major cause of morbidity and mortality worldwide. The most common drugs involved in overdoses are opioid analgesics and benzodiazepines. Men ages 45-49 have the highest death rates. Evaluation involves assessing vital signs and mental status while treatment focuses on stabilization, supportive care, prevention of further exposure, and administration of antidotes if available.
Approach to drug poisoning in adults by Dr Alaa Elmassryalaa massry
This document provides information on drug overdoses and poisonings. It begins with an introduction by Dr. Alaa Eldeen Elmassry. It then poses questions about the epidemiology, toxidrome patterns, therapy, and specific poisonings clinicians may face. The rest of the document addresses these questions and topics, covering areas like cyanide poisoning treatment, opiate overdose signs, toxic ingestion differentials, effects of overdose vs. therapeutic doses, gastric decontamination, paracetamol overdose facts, poisoning statistics, toxic syndromes, vital signs and examinations in poisonings, and diagnostic tests.
This document provides guidance on assessing and managing a poisoned child. It discusses the common causes of pediatric poisoning, important clinical assessments like vital signs and physical exam findings, key investigations like lab tests and toxicology screens, and general treatment approaches focusing on supportive care, decontamination, enhanced elimination, and antidotes. The toxidromes of various substance classes are also reviewed to help identify the potential toxin. A thorough history and physical exam tailored to potential exposures is emphasized for diagnosis and management of the poisoned child.
This document provides an overview of general toxicology. It discusses factors affecting the toxic response, including factors related to the poison and patient. It describes various types of toxins based on origin, site of action, and organ specificity. It also summarizes approaches to managing the poisoned patient, including stabilization, decontamination, and enhanced elimination techniques like activated charcoal, gastric lavage, forced diuresis, and dialysis. Complications and contraindications of different management strategies are also outlined.
This document discusses clinical toxicology and outlines key objectives, common causes of death in poisoned patients, approaches to treatment, and strategies for reducing poison absorption and increasing elimination. The goals are to evaluate vital signs, provide supportive care, determine the poison involved and its location in the body, and initiate specific antidotes or decontamination procedures as appropriate. Specific antidotes are outlined for several common poisons.
The document discusses the evaluation and management of acute poisoning. It defines key terms like poisons, toxins, and toxidromes. It then outlines the steps of evaluation including history, examination, investigations, and management. The assessment and therapy should proceed in parallel and follow advanced cardiac life support principles of evaluating airway, breathing, circulation, and drugs. Signs and symptoms are categorized by system. Guidelines are provided for patient admission to intensive care.
The document provides dietary recommendations for managing hypertensive disorders including following the DASH diet which focuses on fruits, vegetables, whole grains, lean proteins and low-fat dairy while limiting fats, cholesterol, and sodium. Foods high in nitric oxide like beetroot, garlic and leafy greens are recommended to help lower blood pressure. A sample diet plan emphasizes potassium-rich foods like bananas, oranges and spinach to support blood pressure control while limiting sodium to less than 1500mg per day.
This document provides information about counseling patients on inhalers and medications for asthma and COPD. It begins by defining asthma and COPD, and discussing the differences between the two conditions. It then covers the types of asthma and the goals and classes of treatment for asthma. Short-acting beta agonists like albuterol and long-acting beta agonists like salmeterol are described in detail, including dosages. Leukotriene inhibitors like montelukast are also outlined. Finally, inhaled corticosteroids like beclomethasone are discussed, including mechanisms of action, dosages, side effects and drug interactions.
The document discusses drug overdose poisoning and provides information on:
1. Drug overdose occurs when drugs are consumed in excessive amounts, either intentionally or unintentionally, and injure the body.
2. Drug overdose is a leading cause of injury death, especially among those aged 25-64. Opioids and benzodiazepines are commonly involved in overdoses.
3. Risk factors for overdose include being male, white, and between ages 45-49. Children under 15 have the lowest overdose rates.
This document discusses the cuisine of the United States by region. It outlines the historical influences on American cuisine from the pre-colonial, colonial and post-independence periods. Key dishes that are considered typically American include peanut butter, apple pie, eggs and bacon for breakfast, and hamburgers. The document then describes the regional cuisines of New England, the Mid-Atlantic, the South, the Midwest, the Southwest, the West, and Pacific/Hawaiian regions. Each region is known for certain signature ingredients and dishes that were shaped by their history and culture.
The document lists several common herbal medicines and their uses and cautions, including St. John's wort for depression which can interact with sulfonamide antibiotics, garlic for hypertension which should be avoided with aspirin, and ginger root for nausea which can interact with Coumadin. It provides information on potential benefits, drug interactions and cautions for each herbal medicine listed. The document serves as a reference for nurses on key herbal medicines and factors to consider when patients take them.
The document discusses neonatal pain, including that babies can feel and react to pain, validated scales exist to measure neonatal pain, and developmental aspects of pain perception in newborns. It also outlines non-pharmacological and pharmacological approaches to treating pain in newborns, emphasizing the need for comprehensive pain management strategies that minimize unnecessary pain in neonates.
The document provides tips for dealing with picky eaters. It recommends establishing regular meal and snack times to prevent kids from being hungry at meals. Parents should introduce one new food per week and be role models by eating healthy. The document advises against forcing kids to eat, rewarding eating with treats, and allowing distractions during meals. Parents are encouraged to introduce new foods multiple times and explain food groups' importance.
1) Hydrocarbon (such as kerosene) poisoning is common in children in developing countries due to unsafe storage practices. It can cause central nervous system depression, seizures, and chemical pneumonitis if aspirated.
2) Hydrocarbons are classified into aromatic, aliphatic, halogenated, and terpene compounds. Common sources of exposure include petrol, kerosene, and solvents.
3) Management involves resuscitation, intubation for respiratory support, treatment of seizures and dysrhythmias, and observation for 6 hours or more depending on symptoms. Activated charcoal is contraindicated. Outcomes are generally good if not aspirated, but chemical pneumonitis can
Breastfeeding provides ideal nutrition for infants and has numerous health benefits for both mother and baby. It gives babies antibodies and nutrients tailored for them. The document defines breastfeeding as the normal way to provide young infants with needed nutrients for growth. Breastfeeding is recommended exclusively for six months and continued along with complementary foods up to two years or longer. The anatomy and physiology of lactation are described, including milk production triggered by the baby's sucking. Advantages of breastfeeding include its availability, low cost, protection from infection, and psychological benefits. Contraindications for mothers and infants are outlined.
The document provides an overview of 10 top cuisines from around the world, including French, Indonesian, and Mexican cuisine. It describes French cuisine as using sauces, fresh herbs, seafood, poultry and meats, along with regional specialties. Indonesian cuisine is influenced by India, Spain, the Middle East, China, and Portugal, featuring rice, seafood, noodles, tempeh, and spices. Mexican cuisine originated from the Mayans and Aztecs and was later influenced by Spanish introduction of livestock, dairy, herbs, wheat, and spices.
The document discusses infant and child feeding, including breastfeeding, artificial feeding, and introducing solids. It describes the anatomy and physiology of breastfeeding, comparing breast milk to cow's milk. Guidelines are provided for breastfeeding techniques, determining milk supply, introducing formula or solids, and weaning from breastfeeding to solid foods.
The document discusses toxicology and poison control. It provides information on common toxic exposures including drugs, chemicals, plants and animals. Poison control centers provide treatment advice and education on poisonings. They are responsible for toxicology consultation, data collection, education and research. Early identification of poisoning is important for successful management. The majority of poisonings occur in the home and involve young children.
The document discusses the evaluation and management of pediatric toxic exposures and ingestions, including general principles, potentially toxic ingestions of 1-3 tablets, emergency management of airway, breathing, circulation and other systems, decontamination methods, specific toxic syndromes and antidotes, and case examples of ethanol and iron ingestions. Management involves stabilization, decontamination if indicated, treatment of specific toxic effects, and consideration of toxicology studies and antidotes based on the exposure.
This document provides information on acute poisoning, including definitions, common causes, general management approaches, and specific management for certain types of poisoning. It discusses paracetamol poisoning, organophosphorus insecticide poisoning, and opiate poisoning. For paracetamol poisoning, it outlines treatment with acetylcysteine or alternative treatments based on time since ingestion. For organophosphorus poisoning, it describes the triphasic illness and recommends atropine as the antidote. The document provides detailed guidance on assessment, monitoring, supportive care and specific treatments for acute poisoning.
This document discusses drug overdoses, including definitions, common drugs involved, risk factors, evaluation and treatment. It notes that overdoses can be intentional or accidental and are a major cause of morbidity and mortality worldwide. The most common drugs involved in overdoses are opioid analgesics and benzodiazepines. Men ages 45-49 have the highest death rates. Evaluation involves assessing vital signs and mental status while treatment focuses on stabilization, supportive care, prevention of further exposure, and administration of antidotes if available.
Approach to drug poisoning in adults by Dr Alaa Elmassryalaa massry
This document provides information on drug overdoses and poisonings. It begins with an introduction by Dr. Alaa Eldeen Elmassry. It then poses questions about the epidemiology, toxidrome patterns, therapy, and specific poisonings clinicians may face. The rest of the document addresses these questions and topics, covering areas like cyanide poisoning treatment, opiate overdose signs, toxic ingestion differentials, effects of overdose vs. therapeutic doses, gastric decontamination, paracetamol overdose facts, poisoning statistics, toxic syndromes, vital signs and examinations in poisonings, and diagnostic tests.
This document provides guidance on assessing and managing a poisoned child. It discusses the common causes of pediatric poisoning, important clinical assessments like vital signs and physical exam findings, key investigations like lab tests and toxicology screens, and general treatment approaches focusing on supportive care, decontamination, enhanced elimination, and antidotes. The toxidromes of various substance classes are also reviewed to help identify the potential toxin. A thorough history and physical exam tailored to potential exposures is emphasized for diagnosis and management of the poisoned child.
This document provides an overview of general toxicology. It discusses factors affecting the toxic response, including factors related to the poison and patient. It describes various types of toxins based on origin, site of action, and organ specificity. It also summarizes approaches to managing the poisoned patient, including stabilization, decontamination, and enhanced elimination techniques like activated charcoal, gastric lavage, forced diuresis, and dialysis. Complications and contraindications of different management strategies are also outlined.
This document discusses clinical toxicology and outlines key objectives, common causes of death in poisoned patients, approaches to treatment, and strategies for reducing poison absorption and increasing elimination. The goals are to evaluate vital signs, provide supportive care, determine the poison involved and its location in the body, and initiate specific antidotes or decontamination procedures as appropriate. Specific antidotes are outlined for several common poisons.
The document discusses the evaluation and management of acute poisoning. It defines key terms like poisons, toxins, and toxidromes. It then outlines the steps of evaluation including history, examination, investigations, and management. The assessment and therapy should proceed in parallel and follow advanced cardiac life support principles of evaluating airway, breathing, circulation, and drugs. Signs and symptoms are categorized by system. Guidelines are provided for patient admission to intensive care.
This document provides information on psychoactive drugs used to treat psychiatric conditions. It defines psychoactive drugs as substances that act on the central nervous system, altering brain function and resulting in changes in perception, mood, consciousness, and behavior. The document then summarizes several classes of psychoactive drugs - antipsychotics, antidepressants, mood stabilizers, anxiolytics, stimulants, and depressants - listing their indications, mechanisms of action, side effects, and nursing responsibilities for each.
This document discusses poisoning and its management. It begins by defining what a poison is and the different types of poisoning, including deliberate, accidental, environmental, and industrial exposures. It then describes common symptoms of poisoning and considerations for managing poisoned patients, including resuscitation, toxicological diagnosis, and therapeutic interventions like decontamination and antidotes. The diagnostic process involves obtaining a thorough history, conducting a physical exam looking for clues, and ordering targeted toxicology investigations to determine the poison involved and properly manage the patient.
This document provides an overview of toxicological emergencies for nursing students. It defines toxicological emergencies as acute poisonings, overdoses, or substance abuse involving medications, drugs, or chemicals. The document outlines objectives, describes various toxic agents and symptoms of overdose, and explains the nursing process for assessment, diagnosis, treatment, and monitoring of patients experiencing toxicological emergencies. Specific substances discussed include alcohol, opioids, cocaine, amphetamines, inhalants, and several types of medication overdoses. Treatment priorities and interventions are explained for different toxicological situations.
This document discusses the diagnosis and management of uncommon poisonings, including pesticides, herbicides, carbon monoxide, cyanide, and various toxins. It focuses on organophosphate and carbamate poisoning, providing details on the mechanisms of toxicity, clinical features including acute cholinergic syndrome, intermediate syndrome and delayed sequelae. Treatment involves resuscitation, anticholinergic agents like atropine, cholinesterase reactivators like pralidoxime, and other supportive therapies. Paraquat poisoning is also discussed, noting the progression to pulmonary fibrosis and respiratory failure as the main cause of death.
1. The document discusses poisoning management, including causes, types, treatment considerations, and prevention.
2. Key points of management include initial resuscitation, removal of toxins from the body, preventing further absorption, enhancing elimination, and administration of antidotes as needed.
3. Examples of poisoning cases described include food poisoning from contaminated water and inhaled chlorine gas poisoning in a laboratory worker.
This document discusses the principles of managing poisoning and overdose. It begins by listing learning objectives about summarizing poisoning management principles. It then asks questions about determining the type of poisoning and managing patients. The document outlines obtaining a history, vital sign clues to possible agents, clinical characteristics aiding diagnosis, and laboratory tests that can indicate agents. It discusses specific managements like antidotes. General management priorities are maintaining airway, breathing, and circulation. Methods of gastric decontamination and elimination of toxins are covered. The summary is that in treating poisoning/overdose, maintaining airway patency and circulatory stabilization are the initial priorities.
This document summarizes a seminar on poisoning that covered definitions, types, epidemiology, history and physical examination, clinical diagnosis, management principles, and some common poisonings. It defined poisoning as the development of adverse effects from exposure to chemicals, drugs, or other substances. The seminar outlined the epidemiology, types, clinical presentation, diagnostic workup, and management principles for poisonings. It also provided details on the pathophysiology, clinical manifestations, and treatment of specific poisonings including organophosphates, hydrocarbons, and paracetamol.
Toxidromes poisoning in emergency medicineshama101p
This document discusses different types of toxidromes, which are groupings of drugs that cause similar signs and symptoms. The four main toxidromes covered are: 1) anticholinergics, which cause symptoms like dilated pupils, dry skin, and tachycardia; 2) sympathomimetics, which cause symptoms like tachycardia, hypertension, and dilated pupils; 3) opioids, which cause pinpoint pupils, respiratory depression, and sedation; and 4) cholinergics, which cause symptoms like increased salivation, tearing, and bronchospasm. For each toxidrome, example drugs are provided and treatment approaches for overdose are outlined. The document also discusses approaches for diagn
poisoning, its types and emergent management.bhartisharma175
it explain about definition, causes, types of poison, severity , diagnostic evaluation, complication of poisoning, emergent management, supportive management and nursing management.
This document summarizes substance use disorders and alcohol-related disorders. It defines substance dependence and abuse and lists diagnostic criteria. It then discusses the epidemiology, etiology, physiological effects, withdrawal symptoms, and treatments for alcohol use disorder. Key points include alcoholism having genetic and sociocultural influences, various organ system impacts, and benzodiazepines being first-line treatment for alcohol withdrawal and delirium tremens. Memory disorders like Wernicke-Korsakoff syndrome caused by thiamine deficiency are also outlined.
Eczema, also known as dermatitis, is a chronic inflammatory skin disease characterized by itchy, red, swollen and cracked skin. It most commonly presents in children under 5 years old. The exact cause is unknown but involves genetic factors, dry skin, and an altered immune response. Treatment focuses on reducing inflammation, moisturizing the skin, preventing infection, and identifying trigger factors. Proper skin care and use of emollients, topical corticosteroids and immunomodulators can help control symptoms and prevent flare ups of the condition.
This document discusses substance-related disorders and focuses on alcohol-related disorders. It provides information on the classification of psychoactive substances and substance use disorders. Specifically, it defines substance dependence and abuse and lists the criteria. It also describes substance intoxication and withdrawal symptoms. The document then discusses alcohol-related disorders in detail, outlining the types of alcohol use disorder, induced disorders, and the symptoms of alcohol intoxication and withdrawal. It lists the long-term physical effects of alcohol use and risks of high daily consumption.
Lung cancer is the leading cause of cancer death in the United States. Cigarette smoking is responsible for the vast majority of lung cancer cases. The risk of lung cancer increases with age and is higher in African Americans and men. The four main types of lung cancer are small cell lung cancer and non-small cell lung cancers including adenocarcinoma, squamous cell carcinoma, and large cell carcinoma. Symptoms vary depending on location and stage of disease but often include cough, weight loss, and chest pain. Tissue sampling is required for diagnosis. Treatment depends on cancer type and stage but may include surgery, chemotherapy, radiation, or a combination.
This document provides an overview of important anatomical structures of the eye and orbit. It discusses the dimensions of the adult and newborn eyeglobe as well as the three layers (coats) that make up the eyeball. Specific structures of the eye such as the cornea, limbus, sclera, uveal tract, retina, lens, vitreous, and extraocular muscles are described. The document also reviews the bones that form the orbital walls and the paranasal air sinuses located within the orbit. Finally, the lacrimal drainage system is briefly outlined.
The document discusses causes and management of violence and suicide. The most common causes are depression for suicide and substance intoxication/withdrawal for violence. It is important to rule out medical conditions and substance use before making a psychiatric diagnosis. Certain psychiatric disorders like depression, bipolar disorder, and schizophrenia are related to violence and suicide risk. Safety is the top priority for violent patients, which may require restraints, verbal de-escalation, or chemical sedation with haloperidol and diazepam. High-risk suicidal patients should be involuntarily hospitalized based on risk factors.
Somatic symptom disorder, previously known as hypochondriasis, is characterized by at least six months of preoccupation with fears of having a serious illness based on misinterpreted bodily symptoms. This preoccupation causes significant distress and impairment. While prevalence is 4-6% in medical clinics and up to 15%, diagnosis is more common in blacks than whites and transient in medical students. Etiology may involve focusing on and misinterpreting bodily sensations due to faulty cognitive schemas or using illness as an "escape" from problems. Treatment involves psychotherapy and reassurance through medical exams, while avoiding unnecessary tests or treatments. Prognosis is better with social support, treatment of related disorders, and absence of personality disorders.
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
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2. EPIDEMIOLOGY
More than 90% of toxic exposures occur in the home,
and most involve only a single substance.
Ingestion is the most common route of poisoning
exposure (77% of cases),
Other routes- dermal, inhalation, and ophthalmic routes
Approximately 50% of cases involve nondrug
substances, such as common household products
(cosmetics, cleaning solutions, plants, foreign bodies,
hydrocarbons).
Pharmaceutical preparations comprise the remainder,
with analgesics, cough syrups, antibiotics, and vitamins
the most common categories.
2
3. More than 85% of pediatric poisoning exposures can be
managed without direct medical intervention, because
either not very toxic or take in smaller quantity -not
sufficient to produce clinically relevant toxic effects .
Death due to unintentional poisoning in young children is
uncommon
Common causes of poisoning in our set-up are rat
poisons(intentional in adolescents or unintentional in
children), hydrocarbons s. a. kerosene, improperly
placed drugs , cosmetics etc.
Safety measures like “BABY PROOFING”- placing drugs,
detergents and other household chemicals, health
education are some of the measures in preventing
poisoning
3
4. Counseling parents about potential poisoning
risks, how to “poison-proof” a child's environment
How to diminish the likelihood of serious morbidity
or mortality from an exposure
Poisoning exposures in children 6–12 yr of age are
much less common.
Toxic exposures in adolescents are primarily
intentional (suicide, abuse) or occupational.
should be aware of the signs of drug abuse or
suicidal ideation in this population and should be
aggressively intervened.
4
5. INITIAL PATIENT EVALUATION
Once the patient has arrived in the appropriate
medical care setting- first measure should be
taking care of the ABC of life
- Airway management-remove secretions if
excessive, put in lateral position
- Give oxygen if needed
- Treat shock, arrhythmia , seizure etc
History
Description of Toxins.- ask for container
Product names (brand, generic, chemical) and
ingredients, along with their concentrations, may
be obtained from labels.
5
6. Magnitude of Exposure.
-determine how much of the substance has been
ingested.
-estimate the amount (better to overestimate) by
counting the remaining tablets or measuring the
remaining volume of liquid.
-toxicity is usually dose-related- the age or weight
of the child aids in assessment.
-For inhalation, ocular, or dermal exposures, the
concentration of the offending agent and the
length of contact time.
Time of Exposure.
For some products, toxic manifestations may be
delayed for hr or days.
6
7. Historical and Physical Findings in Poisoning
ODOR
Acetone- methanol, paraldehyde, salicylates
Alcohol- Ethanol
Wintergreen - Methyl salicylate
Garlic - Arsenic, thallium, organophosphates
OCULAR SIGNS
Miosis-Narcotics, organophosphates, muscarinic
mushrooms, phenothiazines, barbiturates (late), PCP
Mydriasis -Atropine, alcohol, cocaine, amphetamines,
antihistamines, cyclic antidepressants, CO
Nystagmus- Phenytoin, barbiturates, ethanol, CO
Lacrimation -Organophosphates, irritant gas or vapors
7
14. Poisoning and Drug Overdose: Treatment
General Principles
goals include
1. support of vital signs,
2. prevention of further poison absorption,
3. enhancement of poison elimination,
4. administration of specific antidotes, and
5. prevention of reexposure.
Specific treatment depends on
-the identity of the poison,
- the route and amount of exposure,
- the time of presentation relative to the time of
exposure, and
- the severity of poisoning.
*Knowledge of the offending agents' pharmacokinetics
and pharmacodynamics is essential.
14
15. Fundamentals of Poisoning Management
1. Supportive Care
Airway protection
Oxygenation/ventilation
Treatment of arrhythmias
Hemodynamic support
Treatment of seizures
Correction of T℃ abnorm
Correction of metabolic
derangements
Prevention of secondary
complications
15
16. 2. Prevention of Further Poison Absorption
Gastrointestinal
decontamination
Decontamination of other
sites
Syrup of ipecac–induced
emesis
Gastric lavage
Activated charcoal
Whole-bowel irrigation
Catharsis
Dilution
Endoscopic/surgical
removal
Eye decontamination
Skin decontamination
Body cavity evacuation
16
17. 3.Enhancement of Poison Elimination
Multiple-dose activated
charcoal
Diuresis
Alteration of urinary pH
Chelation
Extracorporeal removal
Peritoneal dialysis and
Hemodialysis
Hemoperfusion
Hemofiltration
Plasmapheresis
Exchange transfusion
Hyperbaric oxygenation 17
18. 4. Administration of Antidotes
Neutralization by
antibodies
Neutralization by
chemical binding
Metabolic antagonism
Physiologic antagonism
5. Prevention of Reexposure
Adult education
Child-proofing
Notification of regulatory
agencies
Psychiatric referral
18
19. During the pretoxic phase, decontamination is the
highest priority, and treatment is based solely on the
history.
Since decontamination is more effective when
accomplished soon after exposure , take focused and
brief Hx.
establish IV access and initiate cardiac monitoring, esp.
in patients with potentially serious ingestions or unclear
Hx.
If you suspect a poison causing delayed toxicity or
irreversible damage is suspected, blood and urine
should be sent for toxicologic screening and, if
indicated, for quantitative analysis.
However, high blood levels of agents whose metabolites
are more toxic than the parent compound
(acetaminophen, ethylene glycol, or methanol) may
indicate the need for additional interventions (antidotes,
dialysis).
19
20. Most patients who remain or become asymptomatic
4–6 h after ingestion will not develop subsequent
toxicity and can be discharged safely.
Longer observation will likely be necessary for
patients who have ingested toxic time-bombs,
agents that are slowly absorbed, slowly distributed
to their sites of action, require metabolic
activation, or disrupt metabolic processes.
During the toxic phase, the time between the onset
of poisoning and the peak effects, management is
based primarily on clinical and laboratory findings.
Effects after an overdose usually begin sooner,
peak later, and last longer than they do after a
therapeutic dose.
20
21. Resuscitation and stabilization are the first priority.
an IV line, oxygen saturation determination, cardiac
monitoring, and continuous observation is needed.
Baseline laboratory, ECG, and x-ray evaluation may also
be appropriate.
Intravenous glucose (unless the serum level is
documented to be normal), naloxone, and thiamine
should be considered in patients with altered mental
status, particularly those with coma or seizures.
Decontamination should also be considered, but is less
likely to be effective during this phase than during the
pretoxic one.
Measures that enhance poison elimination may shorten
the duration of toxicity and lessen its severity. However,
they are not without risk, which must be weighed
against the potential benefit.
21
22. During the resolution phase of poisoning,
supportive care and monitoring should continue
until clinical, laboratory, and ECG abnormalities
have resolved.
Since chemicals are eliminated sooner from the
blood than from tissues, blood levels are usually
lower than tissue levels during this phase and
again may not correlate with toxicity.
This is particularly true when extracorporeal
elimination procedures are used where
redistribution from tissues may cause a rebound
increase in the blood level after termination of
these procedures.
22
23. 1. Supportive Care
The goal is
- to maintain physiologic homeostasis until detoxification
is accomplished and
- to prevent and treat secondary complications such as
aspiration, cerebral/pulmonary edema, rhabdomyolysis,
renal failure, sepsis, coagulopathy, and generalized
organ dysfunction due to hypoxia or shock.
Admission to an intensive care unit is indicated
- for patients with severe poisoning (coma, respiratory
depression, hypotension, cardiac arrhythmias,
hypothermia or hyperthermia, seizures);
- those needing close monitoring, antidotes, or enhanced
elimination therapy; those showing progressive clinical
deterioration; and those with significant underlying
medical problems.
23
24. Respiratory Care
Endotracheal intubation for protection against the
aspiration of GI contents in patients with CNS
depression or seizures.
Mechanical ventilation may be necessary for
patients with respiratory depression or hypoxia.
Cardiovascular Therapy
Maintenance of normal tissue perfusion is critical.
If hypotension is unresponsive to volume
expansion, treatment with norepinephrine,
epinephrine, or high-dose dopamine may be
necessary.
Antibody therapy may be indicated for cardiac
glycoside poisoning
24
25. Supraventricular tachycardia associated with
hypertension and CNS excitation is almost always
due to agents that cause generalized physiologic
excitation
- the etiology could be sympathetic hyperactivity,
RX with a benzodiazepine or Further treatment with a
combined alpha and beta blocker (labetalol), a
calcium channel blocker (verapamil or diltiazem),
or a combination of a beta blocker and a
vasodilator (esmolol and nitroprusside)
- Or high anticholinergic activity
RX with physostigmine
25
26. Central Nervous System Therapies
-Neuromuscular hyperactivity and seizures can lead
to hyperthermia, lactic acidosis & rhabdomyolysis,
with their complications should be treated
aggressively.
-Seizures are best treated with agents that enhance
GABA activity, such as benzodiazepine or
barbiturates.
-Phenytoin is contraindicated in toxicologic seizures:
-For poisons with central dopaminergic effects
(phencyclidine) manifested by psychotic behavior,
use a dopa receptor antagonist like haloperidol.
-Neuromuscular paralysis is indicated in refractory
seizures
26
27. 2. Prevention of Poison Absorption
Gastrointestinal Decontamination
Effectiveness and which procedure to use, depends on
a. the time since ingestion;
b. the existing and predicted toxicity of the ingestant;
c. the availability, efficacy, and contraindications of the
procedure;
d. and the nature, severity, and risk of complications.
The efficacy of activated charcoal, gastric lavage, and
syrup of ipecac decreases with time, esp. when they
are used >1 h after ingestion.
-GI decontamination should be performed selectively, not
routinely.
27
28. a. Activated charcoal
-Activated charcoal suspension (in water) is given
orally via a cup, straw, or small-bore nasogastric
tube.
-The recommended dose is 1 g/kg body weight.
Palatability may be increased by adding a
sweetener (sorbitol) or a flavoring agent
- Charcoal adsorbs ingested poisons within the gut
lumen, allowing the charcoal-toxin complex to be
evacuated with stool.
Advantages
-comparable or greater efficacy,
-fewer contraindications and complications
- is less aversive and invasive
28
29. Disadvantages
-ionized chemicals such as mineral acids, alkalis,
and highly dissociated salts of cyanide, fluoride,
iron, lithium, and other inorganic compounds are
not well adsorbed by charcoal.
-prevent the absorption of orally administered
therapeutic agents
=Complications include mechanical obstruction of
the airway, aspiration, vomiting, and bowel
obstruction and infarction caused by inspissated
charcoal.
Contraindication-in patients who have ingested
corrosives because it obscures endoscopy.
29
30. b. Gastric lavage
-is performed by sequentially administering and
aspirating ~5 mL/kg water or N/S (in infants)
-Place the patient in Trendelenburg and left lateral
decubitus positions to prevent aspiration.
-Lavage decreases ingestant absorption by 50% if
performed within 5 min of ingestion , 25% if performed
at 30 min, and 15% if performed at 60 min. Its efficacy
is similar to that of ipecac.
Complications- aspiration in 10% of patients
- Esophageal ,gastric perforation, misplacement
Containdications
- hydrocarbon, petrolium distilates,corrosive ingestion
- Those with bleeding risks
- Combative, uncooperative patients(absolute)
30
31. c. Syrup of ipecac, now no role in the hospital setting.
-it can still be considered for the home management of
patients with unintentional ingestions, reliable histories,
and mild predicted toxicity when transport to a hospital
site is prolonged.
-Ipecac irritates the stomach and stimulates the central
chemoreceptor trigger zone. Vomiting usually occurs
about 20 min after administration.
Advantage- except for aspiration,serious complications
(e.g., gastric or esophageal tears and perforations) are
rare.
contraindication - patients with recent GI surgery, CNS
depression, or seizures, and in those who have ingested
corrosives or rapidly acting CNS poisons (camphor,
cyanide, tricyclic antidepressants, propoxyphene,
strychnine).
31
34. Whole-bowel irrigation is performed by administering a
bowel-cleansing solution containing electrolytes and
polyethylene glycol (Golytely, Colyte) orally or by gastric
tube at a rate of 2.0 L/h (0.5 L/h in children) until rectal
effluent is clear. The patient must be in a sitting
position.
-appears to be as effective as other decontamination
procedures.
Indication
-for those who have ingested foreign bodies, packets of
illicit drugs, slow-release or enteric-coated
medications, and agents that are poorly adsorbed by
charcoal (e.g., heavy metals).
Contraindications- bowel obstruction, ileus,
hemodynamic instability
34
35. Cathartics are salts (disodium phosphate, magnesium
citrate and sulfate, sodium sulfate) or saccharides
(mannitol, sorbitol) that promote the rectal evacuation
of GI contents.
The most effective cathartic is sorbitol in a dose of 1–2
g/kg of body weight.
Adv- to prevent constipation following a single dose of
charcoal.
Disadv- do not prevent ingestant absorption and should
not be used alone as a method of gut decontamination.
S/E-Abdominal cramps, nausea, and occasional vomiting.
- repeated dosing causes hypermagnesemia and
excessive diarrhea.
Contraindication- in patients who have ingested
corrosives and in those with preexisting diarrhea.
Magnesium-containing cathartics should not be used in
patients with renal failure.
35
36. Dilution (i.e., drinking 5 mL/kg of body weight of water
or another clear liquid) is recommended only after the
ingestion of corrosives (acids, alkali).
Contraindication- increases the dissolution rate (and
hence absorption) of capsules, tablets, and other solid
ingestants and should not be used in these cases.
Endoscopic or surgical removal of poisons may be
useful in
-ingestion of a potentially toxic foreign body that fails to
transit the gastrointestinal tract,
-a potentially lethal amount of a heavy metal (arsenic,
iron, mercury, thallium), or
-agents that have coalesced into gastric concretions or
bezoars (barbiturates, glutethimide, heavy metals,
lithium, salicylates, sustained-release preparations).
36
37. Decontamination of Other Sites
Immediate, copious flushing with water, saline, or
another available clear, drinkable liquid is the initial
treatment for topical exposures (exceptions include
alkali metals, calcium oxide, phosphorus).
Saline is preferred for eye irrigation.
A triple wash (water, soap, water) may be best for
dermal decontamination.
Inhalational exposures should be treated initially with
fresh air or oxygen.
The removal of liquids from body cavities such as the
vagina or rectum is best accomplished by irrigation.
Solids (drug packets, pills) should be removed manually,
preferably under direct visualization.
37
38. Enhancement of Poison Elimination
Multiple-Dose Activated Charcoal
-can enhance the elimination of previously absorbed
substances by binding them within the gut as they
are excreted in the bile, secreted by GI cells, or
passively diffuse into the gut lumen. Doses of 0.5–
1 g/kg body weight every 2–4 h, tapering.
-considered only for selected agents (theophylline,
phenobarbital, carbamazepine, dapsone, quinine)
-Complications include intestinal obstruction,
pseudoobstruction, and nonocclusive intestinal
infarction in patients with decreased gut motility.
-cathartics are absolutely contraindicated when
administering multiple doses of activated charcoal.
38
39. Urinary Alkalinization
Ion trapping via alteration of urine pH may prevent the renal
reabsorption of poisons that undergo excretion by glomerular
filtration and active tubular secretion.
acidic (low-pKa) poisons are ionized and trapped in alkaline
urine, whereas basic ones become trapped in acid urine.
Urinary alkalinization (producing a urine pH 7.5 and a urine
output of 3–6 mL/kg body weight per hour by adding sodium
bicarbonate to an IV solution) enhances the excretion of some
herbicides, phenobarbital, sulfonamides, and salicylates.
Contraindications - CHF, renal failure, and cerebral edema.
Extracorporeal Removal
Peritoneal or hemodialysis, charcoal or resin hemoperfusion,
hemofiltration, plasmapheresis, and exchange transfusion are
capable of removing toxins from bloodstream
39
40. Administration of Antidotes
Antidotes counteract the effects of poisons by
-neutralizing them (e.g., antibody-antigen reactions,
chelation, chemical binding) or
-by antagonizing their physiologic effects (e.g.,
activation of opposing nervous system activity,
provision of competitive metabolic or receptor
substrate).
Some Poisons or conditions have specific antidotes.
Antidotes can significantly reduce morbidity and
mortality but are potentially toxic if used for
inappropriate reasons.
40
41. COMPOUNDS COMMONLY INVOLVED IN PEDIATRIC
POISONINGS
HYDROCARBONS.
Hydrocarbons include a wide array of chemical
substances found in thousands of commercial
products.
produce systemic toxicity, local toxicity, or both.
Nevertheless, aspiration of hydrocarbons into the
lung can lead to serious, even life-threatening
toxicity.
Pathophysiology.
The most important adverse effect of hydrocarbons
is aspiration pneumonitis.
41
42. Aspiration usually occurs at the time of ingestion, when
coughing and gagging are common, but can also be
secondary to vomiting.
The propensity of a hydrocarbon to cause aspiration
pneumonitis is inversely proportional to its viscosity.
Compounds with low viscosity, such as mineral spirits,
naphtha, kerosene, gasoline, and lamp oil, spread
rapidly across surfaces and cover large areas of the
lungs when aspirated.
Only small quantities (<1 mL) of low-viscosity
hydrocarbons need be aspirated to produce significant
injury.
Gasoline and kerosene often cause considerable
gastrointestinal mucosal irritation as they pass through
the intestines.
42
43. absorbed after ingestion, inhalation, or dermal
contact.
have anesthetic properties and can cause transient
CNS depression.
chlorinated solvents s.a. carbon tetrachloride, can
produce hepatic toxicity.
also been associated with renal and bone marrow
toxicity. Benzene is known to cause cancer (AML)in
humans after long-term exposure.
Methylene chloride, found in some paint removers,
is metabolized to carbon monoxide. Some produce
methemoglobinemia.
Most volatile hydrocarbons are being abused.
43
44. Clinical and Laboratory Manifestations.
Transient, mild CNS depression.
Cough usually begins immediately or within 2–5 min of
the aspiration, and persists.
CXR is often will be positive after 6 hr or longer from
the time of exposure.
Respiratory symptoms may remain mild or may
progress rapidly to respiratory failure.
need close clinical monitoring of the patient's
respiratory status.
Fever occurs and may persist for as long as 10 days
Accompanying leukocytosis may be misleading because,
in most cases of aspiration pneumonitis, no bacteria are
present in the lungs.
CXR may remain abnormal long after the patient is
clinically normal, and they should not be used to guide
acute treatment.
44
45. Treatment.
Emesis gastric lavage are contraindicated because
of the risk of aspiration.
If gastric lavage(only in case of highly toxic HCs
s.a. CCl4) is to be performed, the patient should be
intubated with a cuffed tube to protect the airway
from further aspiration.
Activated charcoal also is not useful.
If hydrocarbon-induced pneumonitis develops,
respiratory treatment is supportive .
Corticosteroids and Prophylactic antibiotics should
not be given because bacterial pneumonia occurs
in only a very small percentage of cases.
45
46. CHOLINESTERASE-INHIBITING INSECTICIDES.
The most commonly used insecticides are organophosphates
and carbamates; both are inhibitors of cholinesterase
enzymes.
poisonings occur as the result of accidental exposure to
insecticides in and around the home or farm.
Pathophysiology. –bond to cholinesterase preventing the
degradation of acetylcholine, resulting in its accumulation at
nerve synapses.
Enzymes affected include acetylcholinesterase or red blood cell
cholinesterase, pseudocholinesterase (found in plasma), and
neurotoxic esterase (nervous system).
If left untreated, organophosphates form a permanent bond to
these enzymes, inactivating them.
This process, called aging, may occur as soon as 18 hr to 2–3
days after exposure. A period of weeks to months is required
to regenerate inactivated enzymes.
carbamates form a temporary bond to the enzymes, allowing
regeneration of the enzymes over several hours.
46
47. Clinical and Laboratory Manifestations.
Clinical manifestations relate to the accumulation of
acetylcholine at peripheral nicotinic and muscarinic
synapses and in the CNS.
Muscarinic signs and symptoms include diaphoresis,
emesis, urinary and fecal incontinence, tearing,
salivation, bronchorrhea and bronchospasm, miosis,
hypotension, and bradycardia.
Nicotinic signs and symptoms include muscle weakness,
fasciculations, tremors, hypoventilation (diaphragm
paralysis), hypertension, tachycardia, and dysrhythmias.
CNS effects include confusion, delirium, seizures, and
coma.
Symptoms caused by carbamate toxicity are usually less
severe than those seen with organophosphates.
A commonly used mnemonic for the most common
symptoms-DUMB BELS.
47
48. Treatment.
- A B C of life
-washing all exposed skin with soap and water and immediate
removal of all exposed clothing.
-Activated charcoal can be used for gastric decontamination,
but for insecticides, it is of limited value because these highly
lipid-soluble agents are rapidly absorbed.
-Basic supportive care -including fluid and electrolyte
replacement and intubation, with artificial ventilation,
-if necessary. Two “antidotes” are useful to treat poisoning with
cholinesterase inhibitors: atropine and pralidoxime .
-Atropine, which antagonizes the muscarinic acetylcholine
receptor, is useful for both organophosphate and carbamate
intoxication.
-Pralidoxime chemically breaks the bond thus enhancing the
insecticide's body clearance( only for organophosphate)
48
49. Atropinization
Atropine in sufficient dosage effectively antagonizes
the actions at muscarinic receptor sites, including
increased tracheobronchial and salivary secretion,
bronchoconstriction, bradycardia, and to a
moderate extent, peripheral ganglionic and central
actions.
Larger doses are required to get appreciable
concentrations of atropine into the CNS.
Atropine has no effect against the peripheral
neuromuscular compromise, which can be reversed
by pralidoxime (2-PAM), a cholinesterase
reactivator.
49
50. As an antidote to organophosphate poisoning.
Give atropine 0.02–0.05 mg/kg
every 10–20 min until atropine effect (tachycardia,
mydriasis, fever)etc is seen or features of
muscarinic receptor stimulation symptoms
dissaprear s.a. bronchospasm ,excessive
salivation,myosis etc
then q 1–4 hr for at least 24 hr.
Read on acetaminophen, salysylate, NSAIDs , CO and
caustics poisoning
50