poisoning/near drowning Flashcards
where poisoning occurs
- kitchen & bathroom
- household items
- soaps, cosmetics, detergents, plants, cleaners
- medications (OTCs)
types of poisons
- meds: analgesics, iron
- lead
- caustics: acids & alkalis
- hydrocarbons
- plants
- *usually PO
primary mgmt of poisoning
- ABCs
- ID toxic substance: type, time, route, amt, symptoms
- physical exam: VS, LOC, labs
- decontaminate: prevent further absorption & reverse/eliminate effects
mgmt of poisoning
- ipecac
- gastric lavage
- activated charcoal
- cathartics
- whole bowel irrigation
- antidotes & antagonists
- intubation & gastric tube
gastric lavage
- insert orogastric tube
- instill & aspirate NS until clear
activated charcoal
- insert orogastric tube
- deactivate the poison
whole bowel irrigation
- golytely
- massive ingestion
- pts who don’t tolerate charcoal
- hastens excretion
- minimizes absorption
antidote to narcotics
narcan
antidote to acetaminophen
mucomyst
antidote to benzodiazepines
romazicon
antidote to carbon monoxide
oxygen
antidote to INH
pyridoxine
antidote to aspirin
vitamin K
plumbism
- *lead poisoning
- interferes with normal cell function (RBCs)
- lead is deposited in blood, bone, & soft tissue
sources of lead
- paint chips or dust
- home glazed pottery
- food (lead chromate)
symptoms of lead poisoning
- CNS: irritability, lethargy, learning difficulty, seizures
- GI: anorexia, abd pain
- renal: glycosuria, proteinuria, renal failure
screening for leading poisoning
- blood lead determination >15ug/dl
- CBC
- xray of abd & long bones
- UA, BUN/Cr
- lumbar puncture
treatment of lead poisoning
- remove child from the source
- levels >20ug/dL (use succimer)
- levels >40ug/dL (hospital admission - use BAL & CaEDTA)
commonly ingested toxic agents
- corrosives (cleaners, detergents, bleach)
- hydrocarbons (gas, furniture polish, thinner)
- acetaminophen
- salicylate
- iron
tx of corrosives
- dilute toxin with water
- activated charcoal (no GT)
tx of hydrocarbons
- gastric lavage
- decontaminate skin
tx of acetaminophen
- induce vomiting or lavage
- charcoal and/or mycomyst
tx of salicylate
- induce vomiting
- IV Na bicarb
- Vit k
tx of iron
- induce vomiting
- IVF
- IV Na bicarb
- chelation tx
drowning
death due to suffocation from submersion in liquid within 24 hrs
near drowning
- submersion injury
- requires emergency tx
- survives the first 24 hrs
incidence of near drowning
- 2nd leading cause
- boys>girls
- infants (bathtubs)
- 1-4 yrs old (artificial pools)
- 21% will suffer perm brain dmg
physiologic factors of drowning
- inhale water
- H2O enter larynx
- asphyxia
- larynx relaxes
- aspiration
- surfactant is dmged/gas exchange impaired
- cardiac arrest
mammalian diving reflex
- neurological response triggered by immersion of face in cold water
- lifesaving bradycardia
- brain can function for 7-9 minutes
s/s of drowning depend on…
- length of time submerged
- temp of water
- salt vs fresh water
- response to episode
- tx at the scene
s/s of drowning
- CNS: decreased LOC, cerebral edema, increased intracranial pressure, seizures
- resp: loss of surfactant, irregular respirations, acidosis
- GI: gastric distention
mgmt of drowning
- CPR
- airway/O2/circulation
- intubation
- monitor VS, ABG, electrolytes
- monitor neuro status
- restore normal body temp
- orogastric tube
- antibiotics
- monitor for s/s of cerebral edema
- seizure precations
