Emergency Poisoning Final

8/10/2019 Emergency Poisoning Final

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H ashemite UniversityFaculty Of Nursing

Emergency Poisoning

Done By :-

Mohammad Al Gazo Abeer Trad

Sima Al-Rafati Lina Al- Jaradat


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ObjectivesAt the end of this hour the participants will be able to :

1. identify the definition of poisoning in general , its prevalence and its grade 2. explain how to take history from pt who exposed to poisoning

3. Describe the general management of the poison.

4. classify the types of poisoning related to the material which cause poisoning

5. describe many types of poisoning definition ,signs, symptoms and treatment)

6. Recognized how to prevent the poisoning in general and in specific related totype

7. summarize the poisoning topic .


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Definition

Poisoning

substance interferes with normal body functionsanyPoisoning occurs when-after it is swallowed, inhaled, injected, or absorbed.

- The branch of medicine that deals with the detection and treatment of poisons isknown as toxicology .

- Could be Chemical products, medicines , food, Gas, Bites and stings ofanimals and insects.

- Circumstances of exposure can be intentional, accidental, environmental ormedicinal How ?


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Introduction- Acute Poisoning in children is still an important public health problem and

.frequent cause of admission in emergency unitsrepresents a

- The incidence of childhood poisoning in various studies ranges ].2,1[%7.6% to0.33from

- According to the American Association of Poison Control Centers , over 52% ofpoisonings in 2009 occurred in patients aged 0-5 years [3]. In the first year of life ,

years of3-2At.the main causes of poisoning are medications given by parentsyears of5-3at,house cleaning products cause most cases of poisoning,age

the medications kept in the cupboard or left open are the main causes of,agemedications used for,adolescenceand duringat school age, andpoisoning

].3[committing suicide are the main cause of poisoning

- The mortality rate due to poisoning is 3-5% [1,2,3].

1. Agarwal V, Gupta A. Accidental poisoning in children. Indian Padiatr 1984;11(9):617-21.2. Buch NA, Ahmed K, Sethi AS. Poisoning in children. Indian Padiatr 1991;28(5):521-4.3. American Association of Poison Control Centers 2010


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Con

Research Article
http://localhost/var/www/apps/conversion/tmp/scratch_10/%D9%85%D9%84%D9%81%20%D8%A7%D9%84%D8%B3%D9%8A%D9%85%D9%8A%D9%86%D8%A7%D8%B1/poisoning_in%20jordan.pdf


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Children Act Fast .. So DoPoisons

Thats means poisons are all too easy for a child to find. It only takes seconds for children to grab and swallow somethingthey shouldnt. It can happen in the time it takes you to answer

the phone or the doorbell.

Who are the second most likelygroup to be poisoned ? Why ?

Adult Vs Elderly


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History- What ? - When ? - How much ?

Reliability


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What ?Three What ..

What Type ?- Medication - Food - Hazardous chemical - Gases

What Form ?- Pill - Solid - Liquid - Gaseous

What route ?

- Ingestion - Inhalation - Topical - Intravenous


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Con When ?Elapsed time

How much ?- Estimate amount - Concentration


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irwayAreathingBirculationCraw blood / Laboratory studiesD

econtamination / (depend on site)Dxamine / Physical ExaminationEull vitals / MonitoringFive specific antidotesG

Management


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Chemical Poisoning . Thesepoisonous if swallowedarein the homeMany products used daily

products often contain strong acids or strong alkalis (corrosives). Toxic household cleaning products include :Bleach, dishwashing liquids, floor waxes and furniture polisheslaundry detergents, spot cleaners, toilet bowl cleaners, deodorant hairspray, hairstraighteners, nail polish and polish remover, shampoo etc..


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Corrosives Poisoning(strong acids or alkalis)

Clinical manifestation - Burns to the mouth and severe chest pain as a result of theburning of the esophagus.- White ,swollen mucous membrane's, Edema of lips, tongue andpharynx (respiratory obstruction)- Hemoptysis - drooling


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Treatment1- Induced emesis is contraindicated (To minimizes esophageal injury )

2- Contact poison control center (pcc), immediately , Get medical adviceand treatment .

3- Dont neutralize : neutralization can cause an exothermic reaction(which produces heat and causes increased symptom or produces athermal burn in addition to a chemical burn)

For poisoning call 109


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Con 4- Maintain patent airway as needed5- Dont allow oral intake6- Administer analgesics / Diclofenac sodium 7- For external burn and eye injury wash immediately with water orsaline for 10 to 30 minutes.


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Hydrocarbon Poisoning

Kerosene, Turpentine, Lamp oil, paint thinner


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Con Complication

- Immediate danger is aspiration (even small amounts can cause bronchitis andchemical pneumonia)- Aromatic compounds have mainly neurological and hepatic toxicity and includebenzene compounds.

Clinical manifestations:Choking and coughing, Nausea, Vomiting,Lethargy, Tachypnea, Cyanosis, Retractions


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Treatment1- Induced emesis or gastric lavage is contraindicated for kerosene oilpoisoning (It increase the risk of aspiration).

2- oxygen and respiratory support are indicated. With severe pulmonarycomplications, CPAP or PEEP may be required.

3- Gastric decontamination and emptying are questionable , even whenthe hydrocarbon Contains a heavy metal or pesticide.

,a cuffed endotracheal tube shouldif gastric lavage must be performedbe in place before lavage to decrease risk of aspiration.

4- Symptomatic treatment of chemical pneumonia includes high humidity,hydration and antibiotics for secondary infection


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Prevention 1- Store all products in their original containers , out of the reach of children

2- Do not store or use household products near food

3- Follow all instructions when using household products. Never mix cleaningagents or chemicals together

4- Make sure the area is well-ventilated when using chemicals

5- When you are using a household product, never leave the product in a child's

(e.g., to answer the phone)even for a short time-reach

6- Do not spray chemicals (including pesticides) when children are in the area

7- Teach children never to smell a container to identify what is inside


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Food Poisoning


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Overview

- Organisms- History

- Epidemiology- Transmission- Food borne illness- Prevention and Control


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Organisms

# Estimated 250 food borne pathogens# Food borne illness- 2 or more cases of a similar illness resulting from ingestion of acommon food- Bacteria most common cause- Also viruses, parasites, natural and manufactured chemicals, andtoxins from organisms


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History # Early 1900 s- Contaminated food, milk and water caused many food borneillnesses

# Sanitary revolution- Sewage and water treatment- Hand-washing, sanitation- Pasteurization of milk- 1908- Refrigeration in homes- 1913

# Animals identified as a source of foodbornepathogens- Improved animal care and feeding- Improved carcass processing


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Epidemiology # Food borne diseases each year in US- Affects 1 in 4 Americans- 76 million illnesses- 325,000 hospitalizations- 5,000 deaths 1,500 of those deaths caused by Salmonel la , Lis ter ia , andToxoplasma

# Many unrecognized or unreported- Mild disease undetected- Same pathogens in water and person to person- Emerging pathogens unidentifiable

# Greatest risk- Elderly- Children- Immunocompromised


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Transmission# Oral route

# Contamination varies- Organism, reservoir, handling/processing,cross-contamination

# Human reservoir - Norwalk-like virus, Campylobacter, Shigella # Animal reservoir - Campylobacter, Salmon ella, E. coli 0157:H7, Lis teria, and Tox oplas ma

Contamination can occur at several points along the food chain#

- On the farm or in the field- At the slaughter plant- During processing- At the point of sale- In the home


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Important Organisms - Norwalk-like viruses- Cam py lob acter - Salm on ella

- E. c o li O157:H7- Clos t r id ium b otu l inu m - Sh igella spp- Toxo plasm a - Emerging organisms


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No. of CasesPathogen

6.017Salmonella

5.215Campylobacter

3.021Shigella

480Cryptosporidium

443E. coli 0157

161Yersinia

138Listeria

110Vibrio

15Cyclospora

15.600Total in 2003


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Norwalk-like Viruses # Norovirus ; Caliciviridae family- Most common food borne agent- 23 million cases annually

# Sources- Person-to-person- Shed in human feces, vomitus- Outbreaks in daycares,nursing homes, cruise ships-Contaminated shellfish


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Con # Signs

- 12-48 hours post-exposure

- Nausea, vomiting, diarrhea, abdominal cramps- Headache, low-grade fever - Duration: 2 days- Food handlers should not return to work for 3 daysafter symptoms subside


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Campylobacter jejuni # Leading cause of bacterial diarrhea# 2.4 million people each year - Children under 5 years old- Young adults (ages 15-29)# Very few deaths# Can lead to Guillain-Barr Syndrome- Leading cause of acute paralysis- Develops 2-4 weeks after Campylobacter infection (afterdiarrheal signs disappear)


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Campylobacteriosis

# Sources- Raw or undercooked poultry- Non-chlorinated water -Raw milk-Infected animal or human feces Poultry, cattle, puppies, kittens, pet birds

# Clinical signs- Diarrhea, abdominal cramps,

fever, nausea- Duration: 2-5 days


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Salmonellosis # Gram negative bacteria# Many serotypes can cause disease# S. enteri t idis and t yph imur ium - 41% of all human cases- Most common species in U.S.- 1.4 million cases annually 580 deaths

# Sources- Raw poultry and eggs- Raw milk- Raw beef - Unwashed fruit, alfalfa sprouts

- Reptile pets: Snakes, turtles, lizards

Signs- Onset: 12-72 hours

- Diarrhea, fever, cramps- Duration: 4-7 days


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E. coli O157:H7 # Enter hemorrhagic Esch er ichia col i (EHEC)- Surface proteins; toxin

# Sources- Undercooked or raw hamburger; salami- Alfalfa sprouts; lettuce- Unpasteurized milk, apple juice or cider - Well water - Animals: Cows, other mammals


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Con

# Signs- Watery or bloody diarrhea, nausea, cramps- Onset: 2-5 days- Duration: 5-10 days

# Complication- Hemolytic Uremic Syndrome (HUS)

- Acute kidney failure in children- Life threatening


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Botulism

# Clos t r id ium bo tu l inum - Neurotoxin leads to flaccid paralysis- Infants at greatest risk- Annually: 10-30 outbreaks; ~110 cases

# Sources : Home-canned foods, honey# Signs- Double vision, drooping eyelids, difficulty speaking andswallowing- Onset: 18-36 hours


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Prevention and Control


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At Home


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Watch the video


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MedicationPoisoning

Aspirin (acetylsalicylic


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Aspirin (acetylsalicylicacid)

Acute poisoningClinical manifestation :

Nausea, Disorientation , VomitingDehydration, Diaphoresis, Oliguria, TinnitusComa, Convulsions


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Con Dehydration ,coma , metabolic acidosis andseizures may be more severe ..Bleeding tendencies


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Con - May be caused by acute ingestion(severe toxicity occurs with 500mg/kg )- May be caused by chronic ingestion

( e.g >100mg/kg/day for 2 or more day can bemore serious than acute ingestion )


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T t t


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Treatment

- Hospitalization is necessary for severe toxicity.

- Emesis, Lavage, activated charcoal, or cathartic may be used. - Lavage will not remove concretions of ASA.

- Activated charcoal is important early in ASA toxicity.

, andcorrect metabolic acidosisare used toSodium bicarbonate transfusions-

may be effective in enhancing elimination, urinaryurinary alkalinizationalkalinization is difficult to achieve.

- Be aware of the risk for fluid overload and pulmonary edema - Administer anticonvulsants

- Administer vitamin K for bleeding

.hemodialysis is used,severe casesIn-


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Iron IntoxicationClinical Manifestations

:Occurs in five stages- 1- Initial period ( to 6 hours after ingestion): if child does not developgastrointestinal symptoms in 6 hours, toxicity is unlikely)- Vomiting, Hematemesis, Diarrhea, Hematochezia (bloody stools), Gastricpain

2-Latency (2 to 12 hours): patient improves.

3-Systemic toxicity (4 to 24 hours)

- Metabolic acidosis, Fever, Hyperglycemia, Bleeding, Shock, Death (mayoccur) 4-Hepatic injury (48 to 96 hours)Seizures, Coma

5-Rarely, pyloric stenos is develops at 2 to 5 weeks


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Acetaminophen (paracetamol)

Clinical manifestation Occurs in four stages :

1-initial period (2 to 4 hours after ingestion)Nausea, Vomiting, Sweating, Pallor 2- latent period (24 to 36 hours)Patient improves3-hepatic involvement ( may last up to 7 days and be permanent)Pain in right upper quadrant, Jaundice, Confusion, Stupor,Coagulation abnormalities4-patients who do not die in hepatic stage gradually recover


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Con This is the most common accidental drug poisoning in

children , It occurs from acute ingestion.

Toxic dose is 150 mg/kg or greater in children in children

Because of multiple formulations and concentrations ,chronicAcetaminophen toxicity is a significant problem.

Parents should be counseled to read product packagingcarefully and to a health care professional to avoidinappropriate dosing


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Treatment Antidote N-acetylcysteine (Mucomyst ) can usually be given

orally but diluted in fruit juice or soda because of the antidotesoffensive odor .

Given as 1 loading dose and usually 17 maintenance doses in

different dosages.

May be given intravenously , but use is investigational.


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Research Article
http://localhost/var/www/apps/conversion/tmp/scratch_10/%D9%85%D9%84%D9%81%20%D8%A7%D9%84%D8%B3%D9%8A%D9%85%D9%8A%D9%86%D8%A7%D8%B1/medication.pdf


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Watch the video


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GASPIOSONING

Carbon monoxide


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CARBON MONOXIDE

Carbon monoxide is odorless, tasteless, andcolorless gas is known as the "silent killer." TheCenters for Disease Control estimates thatcarbon monoxide poisoning claims nearly 400lives, and causes more than 20,000 visits tohospital emergency departments annually.


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Sources of carbon monoxide

Gas water heaters Kerosene space heaters Charcoal grills Propane heaters and stoves Gasoline and diesel powered generators

Cigarette smoke Propane-fueled forklifts Gasoline powered concrete saws Indoor tractor pulls Boats engines

Spray paint, solvents, degreasers,and paint removers


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Symptoms Adult Pediatric


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General Dizziness, fatigue, weakness HypoactiveNot feeling well

Neurological Headache, drowsiness,disorientation, fits

Headache, drowsiness, fits,uncoordinated movement

Stomach/intestine Nausea, vomiting, stomach pain Vomiting, stomach pains,anorexia, diarrhea

Loss of appetite

HeartChest pain, palpitations,

hyperventilationHyperventilation


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Carbon Monoxide Poisoning Diagnosis

Because signs and symptoms of carbon monoxide

poisoning are not specific , a blood test / ABGs tolook for it is the most effective way to make thediagnosis.


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FIRST AIDS

FOR INHALATION POISONING:


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FOR INHALATION POISONING:

1. Call for emergency help . Never attempt to rescue a person withoutnotifying others first.

2. If it is safe to do so, rescue the person from the danger of the gas,fumes, or smoke. Open windows and doors to remove the fumes .

3. Take several deep breaths of fresh air, and then hold your breath asyou go in. Hold a wet cloth over your nose and mouth.

4. Do not light a match or use a lighter because some gases can catchfire.

5. After rescuing the person from danger, check and monitor the person'sairway, breathing, and pulse . If necessary, begin rescue breathing andCPR .

6. If the person vomits, clear the person's airway . Wrap a cloth aroundyour fingers before cleaning out the mouth and throat.

7. Even if the person seems perfectly fine , get medical help.

HOW IS CARBON MONOXIDE


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POISONING TREATED?

The first step is to move the affected individual's away fromfurther exposure to the carbon monoxide source.

Their signs and symptoms will then determine what happensnext.

If the individual is only mildly affected they should seek medicalattention, but they may not need to be admitted to hospital. Allother exposed individuals will require hospital treatment.

Administering 100 percent oxygen, via a tightly fitting mask withan inflated face-seal, is the first treatment.


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A high concentration of oxygen in the air beingbreathed will speed up the formation ofoxyhaemoglobin to replace carboxyhaemoglobin.

The severity of the CO exposure can be checked bymeasuring the amount of carbon monoxide in the airbreathed out by the individual or by taking a bloodsample and measuring the carboxyhaemoglobinlevels, and taking these laboratory tests along withthe clinical signs and symptoms present in theaffected person.

Con


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If exposure is deemed to be significant and signs indicate nervedamage, then 'hyperbaric' oxygen therapy should be considered.

This involves placing the individual in a sealed pressure chamber,similar to those used in treating decompression sickness in divers,and exposing the person to oxygen at high pressure.

Using this technique, there's greater penetration of oxygen attissue level, and oxygen displaces carboxyhaemoglobin from thered cells more quickly.

As a guide to who should be offered hyperbaric oxygen therapy,the following indications have been recommended:

loss of consciousness

neurological signs (other than a headache) abnormal heart rhythm or lack of blood to the heart women who are pregnant.

Con

CURE


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*** Inspect your home for hazards.

Your home heating system, chimney, and flue must be inspected andcleaned by a qualified technician every year. Keep chimneys clear ofbird and squirrel nests, leaves, and residue to ensure properventilation.

Be sure your furnace and other appliances, such as gas ovens, ranges,and cook tops, are inspected for adequate ventilation.

Do not burn charcoal inside your house (even in the fireplace). Havegas fireplaces inspected each fall to ensure the pilot light burns safely. Do not operate gasoline-powered engines in confined areas such as

garages or basements. Do not leave a car, mower, generator, or othervehicle running in an attached garage, even with the door open.

Do not block or seal shut exhaust flues or ducts for appliances such as

water heaters, ranges, and clothes dryers.


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Raise the general awareness of the risks associated with carbonmonoxide by communicating the relevant information to friends,family and work colleagues.

Be aware of the sources of carbon monoxide especially indomestic properties where a number of appliances could beresponsible.

Get appliances professionally installed and regularly serviced toensure they work efficiently and safely. Ensure adequate ventilation for all fuel burning appliances. Install monitoring devices for the early detection of excess carbon

monoxide. Recognize the early signs and symptoms of carbon monoxide

poisoning, particularly when more than one family or work memberis affected, and seek medical advice promptly.

Con

CARBON MONOXIDE POISONINGPROGNOSIS


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PROGNOSIS

The prognosis for a person with carbon monoxidepoisoning is difficult to predict.

Death can result from severe cases. Even with proper treatment, some people develop

long-term brain damage, resulting in complicationssuch as severe memory loss, difficulty thinking, orother neurological or psychiatric problems.

Others appear to have no long-term problems.


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Research Article
http://localhost/var/www/apps/conversion/tmp/scratch_10/%D9%85%D9%84%D9%81%20%D8%A7%D9%84%D8%B3%D9%8A%D9%85%D9%8A%D9%86%D8%A7%D8%B1/case%20study%202.pdf


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Watch the video


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Recommendations

Supervise your child and be aware of the dangers in their environment .

Keep medications (including vitamins) out of the reach of children. Rememberthat this place may have to change as the child gets older and more mobile.Use child proof cabinet locks .

Be sure and give the proper dosage of each medication to a child . Adultmedications are usually not appropriate for children .

Never call medicine candy . Do not take medicine in front of a child, becausethey love to imitate .

Keep products in their original containers. Do not switch harmful medicines orhousehold products to familiar food or drink containers.

Remember that children are attracted to products in the same way that adultsare. If a container is pretty or a bright color, or the contents smell good, thereis a greater chance that the child will be curious about it.

American Academy of Pediatrics

2010-2011

DO NOT


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DO NOT

Do NOT give an unconscious person anything by mouth. Do NOT induce vomiting unless you are told to do so by the

Poison Control Center or a doctor. A strong poison that burnson the way down the throat will also do damage on the wayback up.

Do NOT try to neutralize the poison with lemon juice or vinegar,or any other substance, unless you are told to do so by thePoison Control Center or a doctor.

Do NOT use any "cure-all" type antidote. Do NOT wait for symptoms to develop if you suspect that

someone has been poisoned.


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Summary Preventable accidental poisonings are still a significant cause of morbidity among

children in developing countries. Drugs and corrosive agents are the most frequentagents causing poisoning.

Childhood poisonings require supportive treatment, including monitoring andcontinued observation.

Low risk patients with minimal symptoms, nontoxic ingestions, and no expectedComplications may be discharged to caregivers after a short observation period

High-risk patients (e.g., intentional ingestions, patients who exhibit continuedtoxidromes or prolonged symptoms) should be admitted to the hospital for ongoingtreatment and extended observation

Remember this Children Act Fast .. So Do Poisons


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References1. Maternal Child Nursing Care, 2e ( Won g, Maternal Chi ld Nu rsing Care )2. Buch NA, Ahmed K, Sethi AS. Poisoning in children . Indian Padiatr 1991;28(5):521-4.3. American Association of Poison Control Centers 20104- Agarwal V, Gupta A. Accidental poisoning in children. Indian Padiatr 1984;11(9):617-25- http://www.emedicinehealth.com/carbon_monoxide_poisoning6- www.netdoctor.co.uk Lungs Facts on lungs

7-http://pennstatehershey.adam.com/content.aspx?productId=117&pid=1&gid=0000038- http://www.foodsafety.gov9- http://www.cdc.gov/foodsafety10- Van Meter KW. Carbon monoxide poisoning. In: Tintinalli JE, Kelen GD, Stapczynski

JS; American College of Emergency Physicians, editors. Emergency medicine: acomprehensive study guide. 5th ed. New York: McGraw-Hill;2000. p.1303.


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Emergency Poisoning Final