2. Objectives Define poisoning correctly. Enumerate the causes of poisoning in children and adults. Describe the assessment findings and possible toxins that can cause signs & symptoms of poisoning. Discuss the diagnostic tests & treatments for poisoning.
3. Definition Inhalation, ingestion, and injection of, or skin contamination from, any harmful substance. Common environmental emergency. Prognosis depends on the amount of poison absorbed, its toxicity, and the time interval between poisoning and treatment.
6. Adults Chemical company employee chlorine carbon dioxide hydrogen sulfide nitrogen dioxide ammonia Companies that ignore safety standards.
7. Adults Improper cooking Canning Storage of food Ingestion of or skin contamination from plants and accidental Intentional drug overdose or chemical ingestion
31. Toxicology studies Poison levels in the mouth Vomitus Urine Stool or blood, or on the victim’s hands or clothing, confirm the diagnosis. If possible, have the family or patient bring the container holding the poison to the ED for comparable study.
32. Chest X-ray Inhalation poisoning may show aspiration pneumonia. Petroleum distillate inhalation, they may show pulmonary infiltrates or edema. Abdominal x-rays may reveal iron pills or other radiopaque substances.
33. ABG analysis, Serum electrolyte levels & CBC Evaluate oxygenation, ventilation and the metabolic status of seriously poisoned patients.
34. What test tell you . . . Toxicology studies ( including drug screens) of poison levels in the mouth, vomitus, urine, stool or blood, or on the victim’s hands or clothing, confirm the diagnosis. If possible, have the family or patient bring the container holding the poison to the ED for comparable study. In inhalation poisoning chest X-rays may show aspiration pneumonia. In petroleum distillate inhalation, they may show pulmonary infiltrates or edema. Abdominal x-rays may reveal iron pills or other radiopaque substances. ABG analysis, serum electrolyte levels, and CBC are used to evaluate oxygenation, ventilation and the metabolic status of seriously poisoned patients.
39. Poisoning victim Exhibits altered LOC routinely receives oxygen, glucose, and naloxone. Activated charcoal Effective in eliminating many toxic substances. Specific treatment depends on the poison.
41. Poisoning victim Prevent further absorption by administering activated charcoal, including emesis, or by administering gastric lavage and cathartics for specific treatment, contact the poison center. The treatment’s effectiveness depends on the speed of absorption and the time elapsed between ingestion and removal.
42. Emesis Never induce emesis if you suspect corrosive acid poisoning, if the patient is unconscious or has seizures or if the gag reflex is impaired, even in a conscious patient. Instead, neutralize the poison by instilling appropriate antidote by an NG tube. Common antidotes include milk, magnesium salts, activated charcoal, or other chelating agents, such as deferoxamine and edetate disodium.
43. Intravenous Therapy Use large quantities of I.V. fluids to force the poison through the kidneys to be excreted. Kind of fluid you use depends on the patient’s acid-base balance and cardiovascular status and on the flow rate necessary for effective diuresis of poison. If ingested poisoning severe and requires peritoneal dialysis or hemodialysis, assist as necessary.
44. Inhaled poison Prevent further absorption of inhaled poison, remove the patient to fresh or uncontaminated air. Provide supplemental oxygen and , if needed, intubation. Prevent further absorption from skin contamination, remove the clothing covering the contaminated skin and immediately flush the area with large amounts of water.
45. Inhaled poison If patient is in severe pain, give analgesics as ordered frequently monitor fluid intake and output, vital signs and LOC. Keep the patient warm and provide support in a quiet environment. If the poison was ingested intentionally, refer the patient for counseling to help prevent future attempts at suicide.
Facts : Adolescents tend to overdose on over-the-counter drugs instead of prescription drugs. Elderly patients who overdose do so usually because of polypharmacy, improper use of their prescribed medication, improper storage of the medication, improper storage of the medication ( not in its original container ), or mistaking identity of the medication..
Because of their curiosity and ignorance, children are the most common poison victims. In fact, accident poisoning ( usually from the ingestion of salicylates (aspirin), cleaning agents, insecticides, paints, cosmetics and plants ) is the fourth leading cause of death in children. In adults, poisoning is most common among chemical company employee – particularly those in companies that use chlorine, carbon dioxide, hydrogen sulfide, nitrogen dioxide, and ammonia – and in companies that ignore safety standards. Other causes of poisoning in adults include improper cooking, canning, and storage of food, ingestion of or skin contamination from plants and accidental or intentional drug overdose (usually barbiturates) or chemical ingestion.
The pathophysiology of poison depends on the substance that’s inhaled or ingested. The extent of damage depends on the pH of the substance, the amount ingested, its form ( solid or liquid), and the length of exposure to it. Substance with alkaline pH cause tissue damage by liquefaction necrosis, which softens the tissue. Acids produce coagulation necrosis. Coagulation necrosis denatures (changes the molecular composition of) proteins when the substance contacts tissue. This limits the extent of the injury by preventing penetration of the acid into the tissue.The mechanism of action for inhalants are unknown but they’re believed to act on the CNS similarly to a very potent anesthetic. Hydrocarbons sensitize the myocardial tissue and allow it to be sensitive to catecholamines, resulting in arrhythmias.
Coagulation necrosis denatures (changes the molecular composition of) proteins when the substance contacts tissue. This limits the extent of the injury by preventing penetration of the acid into the tissue.
The patient history should reveal the poison’s source and form of exposure ( ingestion, inhalation, injection, or skin contact). Assessment findings vary with the poison.
Prevent further absorption by administering activated charcoal, including emesis, or by administering gastric lavage and cathartics ( magnesium sulfate) for specific treatment, contact the poison center ( local or national). The treatment’s effectiveness depends on the speed of absorption and the time elapsed between ingestion and removal.
Never induce emesis if you suspect corrosive acid poisoning, if the patient is unconscious or has seizures or if the gag reflex is impaired, even in a conscious patient.Instead, neutralize the poison by instilling appropriate antidote by an NG tube. Common antidotes include milk, magnesium salts ( Milk of manganese, activated charcoal, or other chelating agents, such as deferoxamine and edetate disodium.
If several hours have passed since the patient ingested the poison, use large quantities of I.V. fluids to force the poison through the kidneys to be excreted. The kind of fluid you use depends on the patient’s acid-base balance and cardiovascular status and on the flow rate necessary for effective diuresis of poison. If ingested poisoning severe and requires peritoneal dialysis or hemodialysis, assist as necessary.
