PRESENTED BY

ASEEM.B

ASSISTANT PROFESSOR

SP FORT COLLEGE OF

NURSING

THIRUVANANTHAPURAM

POISONING

Relax……………………….

POISONA Poison is any chemical that harms the

body

It can be

-Accidental

-Occupational

-Recreational

-Intentional (killing)

-Natural or Manufactured toxins

Bio weapon poisoning

Mode of Absorption Ingestion Inhalation InjectionSplashing in to the eyeAbsorbed through the skin (Inuction) Insufflation (the act of blowing gas or a powder in to a

body cavity)

Main types of poisonsAcids AlkaliesMedicationMetal poisoningOrganophosphorous poisoningPetroleum productsOils

Acids Nitric acidsH2SO4HCLCarbolic acidAcetic acid

AlkaliesDrain cleanersDishwashing – detergents,

ammoniaBleaches

Medication Aspirin & Aspirin containing

medicationsNSAIDSHallucinogen BarbituratesAlcohol (in homeo treatment : spirit)

Metal poisoningIronCopperCyanideLeadEthylene glycol

Arsenic poisoning

OP poisoningInsecticides naphthalenePesticidesOpiumCastor oilMushroomTobaccoCannabis

baby with birth defects attributable to pesticides (PBP)

Spraying insecticides

Cerbera_odollam

Winai Wananukul, Ramathibodi Poison Center

What is Acute Organophosphate & Carbamate Poisoning ?

State of Acetylcholine Excess

It is a combination of◦Muscarinic receptor◦Nicotinic receptor◦CNS (unspecified)

Clinical ManifestationMuscarinic effectsNicotinic effectsGeneral symptoms

MUSCARNIC EFFECTS (antidote : atropine)- Miosis- Salivation- Bradycardia- Diarhoea- Sweating- Pulmonary edema- hypersecretion

NICOTINIC EFFECTS(antidote : Pralidoxime -PAM)Fasciculation(brief spontaneous

contraction of a few muscle fibers)

Muscle paralysisCNS symptoms- Coma- Bradycardia- Hypotension- Respiratory depression

General symptomsConvulsionsCrepitations in the chest for evidence of

aspiration (soft fine crackling sound heard in the lungs through the sthethescope)

HypotensionBradycardiabradypnoea

ANXIETY AND DEPRESSION

Diagnosis

diagnosisHistory (bystanders, patient is

able/conscious if )Respiration and cyanosisCondition of skinSize of the pupil – small in OP poisoning

and large in cocaineSmell near the patient and gastric content

ManagementCatheterisation, RT, establish

patent airwayIV line vascular access, gastric

lavageAdministration of activated

charcoal orally or via gastric tube within 60 minutes of poison ingestion. Many toxins adhere to charcoal and excreted through GI tract rather than absorption in to the circulation

TOXIC

ANTIDOTES

Muscarinic EffectsHeart rateSweating SecretionPupils

Atropine

Nicotinic EffectsMotor Power

+ (Muscarinic Effects)

2 PAM

Medical managementAtropine sulphate1ml=0.6mg5 ampule iv bolusAtropine infusionAtropinisation-delirium-restlessness-mydriasis(dilated and

fixed pupil)-decreased secretion-fever, tachycardia,

dryness of tongue

Pralidoxime(PAM)1-2gm IV statRepeat every

8hoursit is most effective within 24 hours of consuming poison

- Antibiotics(prevent UTI and respiratory infection)

- H2 receptor antibiotics

- IV fluids Multivitamin

Skin and outer decontaminationIt involves the removal of toxins from

eyes and skin using copious amount of water or saline

Dry substances should be brushed from the skin

Remove the clothes before water is used(personal protective devices should be

used like goggles gowns respirators etc)

Bowel managementCathartics (sorbitol) are given together

with the first dose of charcoal to stimulate intestinal motility.

Whole bowel irrigation involves the administration of bowel evacuant solution(eg: goly-tely).this solution is administered every 4-5hrs until stool are clear.

It is effective for swallowed objects for cocaine filled baloon or condoms, and heavy metals such as lead and mercury

Baloon filled coccaine

Hemodialysis (severe acidosis patients) for eg methanol, lithium, phenobarbitone poisoning

Alkanization – sodium bicarbonate administration raise the pH greater than 7.5

Chelation therapy for heavy metals poisoning. We will give edetate calcium disodium (calcium EDTA)

IV Fluids – multivitamin and correction of electrolyte.

Check ABG daily

GeneralEducation to toxic emergenciesOccupational safety and health

administrationMental health counsellorAlcohol /drug detoxification

Nurses responsibilityInform policeReport MLCCollect information from the

surrounding persons/bystandersPreserve the suspending material

like bottle containing pills or liquid

Preserve the vomited material.

MLC is important….

Thank you for listening :-)

Thank uuuu…….Relaxxx