Poisoning (p 295)

Question 1

Poisoning

Answer 1

is the exposure by :
Ingestion
Inhalation
absorption
infection to a gquantity of a substance that may result in illness or death.

Question 2

Toxidromes

Answer 2

A toxidrome is a collection of signs and symptoms associated with a particullar class of toxins.
- sympathomimetic (causes: caffeine, cocaine, amphetamine, LSD, MDMA (extasy) , Alchohol/drug withdrawal)
- anticholinergic ( atropine, olanzapine…)
- cholinergic ( nicotine, nerve agents such as sarin, organophosphates)
- opioid ( morphine, codeine, tramadol, heroin, hydrocodone)
- dedative-hypnotic ( barbiturates, benzodiazepines such as diazepam. lorazepam, zopiclone, drug of abuse such as GHB)
- seretonin syndrome ( MDMA, amphetamines, antidepressant; sertraline)
- alkohol

Question 3

Poisoning signs and symptoms

Answer 3

• altered level of consciousness (LOC)
  -decreased airway reflexes
• hypotension

Question 4

Posioning management

Answer 4

mneumonic RESUS - RIS- DEAD
Resus (ciatation) : ABC D: detect and correct :
- hypoglyceamia
- seizures
- hyper/ hypothermia
E: emergency andtidote administration

RISK assessment: drug, dose, time since ingestion , clinical features and course, patient factors
Supportive care and monitoring
Investigation: screening : 12 ECG, paracetamol
Specific: Decontamination, Enhanced elimination, Antidotes, Disposition

Question 5

Antidotes

Answer 5

Naloxone for opiads overdose
Atropine for orangophosphorus agent intoxication
anti venom for snake bites

Question 6

paracetamol toxic dose

Answer 6

75 mg/kg

Question 7

Toxbase and NPIS

Answer 7

Toxibase online base
NPIS (national Pisons information service by phone

Question 8

overdose patient

Answer 8

all aunconscious patient should have a serum paraetamol level checked in hospital
- 12 EGC, look for bradycardia/tachycarida,
- qrs prolongation
- heart block
- qt prolongation

Question 9

Charcoal

Answer 9

within 1 hour of ingestion, fully conscius and able to protect their own airway
- note: voiting occurs in 30 % of patient given activated charcoal within an hour.
- it is ineffective if the posions are: hydrocarbons, alcohols, metal or corrosives

Question 10

Suitable for leaving at home critiria

Answer 10

• the substance is verified by toxbase or NPIS as being harmless
• a responsible adult is present
• advice is provided to the patient to seek medical advice if they become unwell
• the patints health visitor or GO is informed.

however:
all intentional overdoses should have a mental health assessment.

Question 11

poisoning toxidrome initial treatment

Answer 11

• Alcohol :pt will need monitoring and suportive treatmmetn while they recover, it can lead to hypotheria and/or hypoglycaemia. always measure the blood glucose of any confused pt,
  Alcohol can enhance the effect or other drugs such as opiats or benzodiazepines , if taken simultaneously.
• Opiats: main concern is respiratory depression, focus on patient airway and ventilating if required, maintain o2 and ETCO2, administer IM naloxone

Caustic irritant - encourage the patient to drink a cup of milk . do not induce vomiting.

Paracetamol - even small amounts taken in overdose can be dangerous. Pt will need blood measurements.
if possible - give charcoal to reduce the amount of parac. being absorbed into the body.