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
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
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)
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
5
Q
Whate kind of neutralization can we do?
A
- Alkali-therapy (5% NaHCO3, 2% Na-lactate)
- Specific antitoxins
- Neutralization by antibodies