Management of poisoned patients Flashcards

1
Q

Critical care steps?

A

A. Airway obstruction

B. Oxygenation/ventilation

C. Treatment of arrhythmias

D. Hemodynamic support

E. Treatment of seizures

F. Correction of temperature abnormalities, metabolic derangements

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2
Q

Which kind of decontamination can we do?

(prevent further poison absorption)

A

GIT:

  • Induction of emesis:
    • Done by syrup of ipecac or apomorphine (rarely)
    • Contraindication: unconscious, poisoned with corrosive agents, convulsants, petroleume distillate
  • Gastric lavage:
    • Possible protection of airways by endotracheal tube
    • Contraindication: poisoned with corrosive agents, convulsants, petroleume distillate
  • Whole bowel irrigation (gastric tube):
    • ​6-8L of isosmotic physiologic electrolyte solution, containing polyethylene glycol
  • Catharsis:
    • ​With Sorbitol
    • Contraindicated in paralytic ileus

Eye (at least 20min)

Skin

Body cavity evacuation

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3
Q

What kind of enhancement of poison elimination can we do?

A

GIT:

  • Multiple-dose activated charcoal (“gut dialysis”)
  • Cholestyramine in digital intoxication (decrease abosption)

Kidney:

  • Forced diuresis (infusion, mannitol, loop diuretics, …)
    • Not very effective and risk of lung edema and electrolyte imblanace
  • Alteration of urinary pH
    • Excretion of weak acids if urine is basic (NaHCO3)
    • Excretion of weak bases if urine is acidic (NH4Cl - risk of myoglobin precipitation)
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4
Q

What kind of extracorporal removal can we do?

A

Dialysis:

  • Peritoneal or hemodialysis
  • Molecules diffuse through membrane following concentration gradient. Done with water soluble compounds, with low molecular mass and that don’t bind strongly plasma proteins (e.g. Antibiotics, heavy metals, salicylates, Bz)

Hemoperfusion:

  • Removing drugs by passing blood into adsorbent material and back to patient. Higher affinity to material means higher removal. (e.g. organophosphates, barbiturates, digoxin, …)

Plasmapheresis:

  • Removal of cellular components from blood –> suspended in colloids, albumin, plasma proteins –> reinfused
  • Complication: thrombocytopenia and/or microembolism
  • Indicated: carbamazepine, lithium, methanol, metformin, phenobarbital, salicylate, theophylline, valproic acid
  • Ineffective: amphetamine, antidepressents, antipsychotics, Bz, Ca channel blockers, digoxin, metoprolol, opioids, propanolol, quinidine intoxication
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5
Q

Whate kind of neutralization can we do?

A
  • Alkali-therapy (5% NaHCO3, 2% Na-lactate)
  • Specific antitoxins
  • Neutralization by antibodies
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