Emergency Managment If Poisoning Flashcards
Stabilizing the patient
Airways —>intubate
Breathing —> ventilate
Circulation —> PRN
Disability —> reflexes
Respiratory failure or depression
A patent airway
Cuffed endotracheal tube
Mechanical ventilation or oxygen (apnea, anoxia, severe anemia)
How do you treat respiratory failure?
Doxapram- respiratory stimulant
Naloxone- If opiate induced
Seizures
Comes with hypoxia, hyperthermia and acidosis
Use diazepam, phenobarbital and pentobarbital
Diazapam
Drug of choice for acute seizures (prototype drug)
Usually re-administered every 10-20 minutes
Phenobarbital
Use if diazapm is ineffective
Can cause respiratory depression with excessive prolonged use
Pentobarbital
Use to induce light anesthesia for refractory seizures
Excessive or prolonged use may cause CNS depression
CNS depression
Opiate pain meds: tramadol
Nalaxon (Narcan)
Useful for opiate induced respiratory depression
Reduces opioid overdoses (antagonist)
Shock
Toxicants: cause fluid loss, vomiting, diarrhea, blood loss and cardiomyopathy
Monitor using Hb, PCV, and oxygen saturation
Treating shock
Lactated rings solution, plasma expanders and whole blood
Hyperthermia
Cold baths, ice packs and cooled IV fluids
Rehydrated with fluid therapy
Hypothermia
Blankets, warm water bottles and heating pads
Warming the animals surroundings
Prolonged vomiting or diarrhea possible etiologies
Toxicants: Organophosphate toxicosis
CNS causes or local irritation
Treatment for prolonged vomiting or diarrhea possible etiologies
Atropine
GI hyperactivity
Helps to eliminate ingested toixcants →dehydration, acid base disturbances and electrolyte loss
Histamine-type 2 receptor blockers
Cimetidine in dogs orally –> clinical improvement of simple gastritis
Emesis
Removing poisons from the stomach (vomit)
Most effective first 2 hours post ingestion
Least effective if > 4 hrs
How do you achieve emesis?
Physically (avoid)
Ipecac (humans), hydrogen peroxide
Pharmaceuticals (apomophine, xylazine and ropinirole/ clevor)
Ipecac
Used orally in dogs and cats
Bitter taste and potential toxicity
Excessive vomiting, CNS depression
Hydrogen peroxide
3% concentration
@ 1 tsp/10 lb bwt and wait 15-20 minutes
May repeat dose if needed, use after meal
Ropinirole (clevor) in dogs
Eye drops (FDA approve fro dogs)
Stimulates D2 receptores in CRTZ
Contraindications for emesis
Unconscious, depressed animals
Seizures or spontaneous seizures
Exposed to corrosive or caustic chemicals
Volatile materials (gas, petroleum, hydrocarbons)
Which animals shouldn’t emesis be practiced on?
Rats, horse, rabbits and ruminants
Catharsis
Enhancing elimination (defecation)
Sorbitol (most rapid/ potent)
Lactulose, Magnesium SO4, epsom salts, castor oil
Gastric Lavage
Alternative of decontamination GIT
Used when emesis ineffective/ contraindicated and unconscious/ anesthetized patient
Used along with endotracheal tube to prevent aspiration of stomach contents
Activated charcoal (AC)
Adsorbent
Given following gastric lavage and when emesis is contraindicated
Dosage: 2-5 g/kg in water slurry
Gastrotomy/ rumenotomy
Used refractory to emesis, lavage or activated charcoal
Indications: foreigns bodies, abnormal rads
Persistent materials in the GIT
Toxic oils, tars, agents that reduce rumen motility
Forced diuretics
Rapid renal filtration
Furosemide and mannitol (cerebral edema)
Caution with use of diuretics
Excessive fluid administration comes with cerebral edema, pulmonary edema and disturbance of acid-base or electrolyte status
Ion trapping
To enhance elimination:
Acidic drugs (aspirin), basic drugs (amphetamines), agents use to change pH
Acid urine is promoted by ____________
Ammonium chloride
Alkaline urine is promoted by _________
Sodium bicarbonate
When is peritoneal dialysis used?
Useful failure and anuria cases
Ocular exposure to toxins (decontamination)
Immediate flushing with water
Repeated many times (20-30 minutes)
Dermal exposure of toxins
Bathe –> warm water and soap, mild detergent, repeat prn
Clipping to remove toxic residues from long haired animals
