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Supportive care

Supportive care. Supportive care. Nursing care. Initial resuscitation based on assessment of the patient. Psychiatric care. Initial resuscitation based on assessment of the patient. Initial resuscitation should be done based on the assessment of the patient and not on the toxin ingested.

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Supportive care

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  1. Supportive care

  2. Supportive care Nursing care Initial resuscitation based on assessment of the patient Psychiatric care

  3. Initial resuscitation based on assessment of the patient • Initial resuscitation should be done based on the assessment of the patient and not on the toxin ingested. • Assessment includes • Airway • Breathing • Circulation • Depression • Evaluation (Hyper & Hypokalemia, Natremia, Calcemia)

  4. 1.1 Airway and breathing Signs & Symptoms of airway obstruction includes • Dyspnoea • Air hunger • Hoarseness • Cyanosis • Sweating • Tachypnoea • Measuring blood gases. Ventilation is required if • PaCO2 > 45 mmHg • PaO2 <70 mm Hg

  5. Management of respiratory insufficiency

  6. 1.2. Circulation

  7. Management of circulatory failure • Elevate foot end of the bed • Insert a large peripheral IV line and administer 200ml of saline. Observe for improvement in BP over 10 min. • If fails, repeat IV bolus of saline upto 2 litres. • If fails, then vasopressors such as dopamine 1-5 µg/kg/min or noradrenaline 0.5 – 1 ml/min.

  8. Management of cardiac arrythmias • Obtain an ECG • Evaluate for hypoxia, acidosis and electrolyte disturbances (hypokalemia, hypocalcaemia and hypomagnesaemia). • Lignocaine – 1.5 mg/kg iv and • amiodarone – 4 mg/min first line drugs • Atropine – used in severe bradycardia

  9. Management of depression

  10. 2.6 Electrolyte disturbances

  11. 2.6 Electrolyte disturbaces

  12. 2.6 Electrolyte disturbaces

  13. 2.6 Electrolyte disturbaces

  14. Nursing care This is especially important in comatose patients, and involves the following measures: • Attention to pressure points to prevent the development of decubitus ulcers—hourly turning, a pillow between the legs, use of a ripple mattress if available, etc. • In the absence of spontaneous blinking, avoid exposure keratitis by methyl cellulose eye drops, and if necessary, secure the eyelids with adhesive tape.

  15. Nursing care • Change bed linen frequently if it gets soaked with urine or stained with faeces. 4. Urinary incontinence can be managed with a sheath urinal for a male, but for a female, an indwelling silastic catheter inserted with aseptic precautions is necessary. 5. Inhalation of gastric contents is a frequent problem which can lead to pneumonitis. This can be prevented by positioning the patient semiprone with the head slightly dependent.

  16. Psychiatric care • A significant proportion of overdose cases comprise suicide attempts. • After medical stabilisation, the most important aspect of management consists of psychiatric counselling in order to prevent recurrence of suicide ideation once the patient has been discharged.

  17. Psychiatric care • Any patient who has taken an overdose or manifests suicidal ideation should get psychosocial assessment and support as early as possible. • The initial evaluation can be performed prior to a total clearing of the patient’s sensorium, but a final assessment should not be made unless the patient is completely alert.

  18. Psychiatric care • Carefull and precise analysis of the patient’s psychologic state (depressed, uncooperative, unresponsive, agitated, anxious, violent, or psychotic), will allow for a realistic appraisal of the psychosocial alternatives with respect to immediate and long-term treatment, disposition, and continued follow-up, or outpatient care.

  19. Psychiatric care • According to one survey, oral ingestions account for 78% of the cases, • 13% are inhalational, • while 5% are due to parenteral intake. • Patients suffering from depression commit suicide 50 times more frequently than the general population.

  20. Psychiatric care • Alcoholics and chronic dialysis patients have a suicide rate 6 times higher than the population at large. • After the age of 40 years, the suicide rate begins to climb, with a dramatic increase after 65. • Women attempt suicide 3 times more often than men, but men are more successful by a ratio of 3:1.

  21. Psychiatric care • With prompt recognition and referral, many suicides may be prevented. • A patient with a past history of previous suicide attempts, vague health problems of recent onset, recent surgery, alcoholism, drug abuse, and mental unsoundness (especially psychosis), is at high risk. • Stress is also a major factor leading to suicide ideation; loss of a job, financial loss, etc. are well recognised as trigger factors.

  22. Psychiatric care • Psychosocial assessment has become an important component in the comprehensive evaluation of toxicologic emergencies.

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