1 / 36

MANAGEMENT OF ACUTE POISONING

MANAGEMENT OF ACUTE POISONING. Kent R. Olson, MD Medical Director - SF Division California Poison Control System. Lessons from history. A young princess ate part of an apple given to her by a wicked witch She was found comatose and unresponsive, as if in a deep sleep

morley
Télécharger la présentation

MANAGEMENT OF ACUTE POISONING

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. MANAGEMENT OF ACUTE POISONING Kent R. Olson, MD Medical Director - SF Division California Poison Control System

  2. Lessons from history... • A young princess ate part of an apple given to her by a wicked witch • She was found comatose and unresponsive, as if in a deep sleep • Airway positioning and mouth to mouth ventilation were performed, and she recovered fully

  3. Lesson: Best antidote = good supportive care (Love’s first kiss)

  4. Young man collapsed on the street outside a dance club Unresponsive Shallow breathing Case:

  5. Airway Breathing Circulation Dextrose, drugs, decontamination Initial management: ABCDs

  6. Major cause of morbidity in OD Risks: Floppy tongue can obstruct airway Loss of protective reflexes may permit pulmonary aspiration of gastric contents Airway issues

  7. “Gag” reflex Indirect measure May be misleading Can stimulate vomiting Alternatives Assessing the airway

  8. Assess visually ABG: pCO2 reflects ventilation Pulse oximetry provides convenient, noninvasive evaluation of O2 saturation Breathing

  9. pO2 measures dissolved oxygen Pulse oximetry can miss abnormal hemoglobin states, eg: Carbon monoxide Methemoglobinemia Pitfalls

  10. Endotracheal intubation Protects airway Allows for mechanical ventilation Reverse coma? Naloxone: note T½ = 60 min Flumazenil? Interventions

  11. “A stroke is never a stroke until it’s had 50 of D50” Give Thiamine 100 mg IM or in IV Don’t forget GLUCOSE

  12. The patient has no gag reflex, and does not resist intubation. However, he is awake and sitting up 2 hours later. Admits to using “GHB” Case, continued…

  13. Gamma Hydroxybutyrate Rapid-acting general anesthetic Structural analogue of GABA Very short duration May see seizure- like movements or hypertonicity GHB

  14. 47 year old stockbroker attempts suicide BP 70/50, HR 50/min Junctional rhythm Hx: uses an antihypertensive Case 2

  15. Pump working? Enough volume (is it primed)? Adequate resistance (no leaks)? Circulation = plumbing

  16. Hypovolemia? IV fluid challenge Pump? Dopamine Inadequate vascular resistance? Norepinephrine, phenylephrine Management of Hypotension

  17. Diuretics Beta blockers Calcium channel blockers ACE Inhibitors Centrally acting agents (eg, clonidine) Vasodilators Antihypertensives

  18. Bad ODs!! Low Toxic:Therapeutic ratio High mortality Calcium channel blockers

  19. Decreased Automaticity & Conduction Negative Inotropic Effects Dilated Vascular Smooth Muscle SVR HR CO AV Block SHOCK

  20. Calcium High doses may be needed Calcium antagonists - treatment

  21. Another patient arrives from the first dance club Multiple seizures with only brief pauses Temp 107 F! Case 3:

  22. TCAs Amphetamines/cocaine Isoniazid (INH) Diphenhydramine Theophylline Strychnine Common causes of seizures

  23. Disastrous complication! Brain damage Cardiovascular collapse Rhabdomyolysis Multiple organ failure Hyperthermia

  24. Stop the seizures Benzodiazepines, phenobarbital Vitamin B-6 for INH Stop muscle hyperactivity Neuromuscular blockers External cooling Hyperthermia - Treatment

  25. Limit systemic absorption Induce vomiting? Pump the stomach? Activated charcoal Gut decontamination after OD

  26. Syrup of Ipecac? Soapy water? Don’t use: Finger gag Salt water Copper sulfate Induce vomiting

  27. Easy to perform, but Not very effective Contraindicated: Comatose/convulsing Ingested corrosive or hydrocarbon Rapid-acting CNS agent No longer used Ipecac-induced emesis

  28. Cooperation not required MD sense of “control” Punitive value? Pumping the stomach

  29. May stimulate gagging, vomiting Risky if airway reflexes dulled Lack of proven efficacy Used rarely Gastric lavage

  30. Finely divided powdered material Huge surface area Binds most drugs/poisons Exceptions:- Iron- Lithium Activated charcoal

  31. More effective than SI, GL First choice for most ODs Activated charcoal

  32. Mechanical flush Balanced salt solution with PEG No net fluid gain/loss Good for: Iron Lithium Sustained-release pills, foreign bodies Whole bowel irrigation

  33. The best antidote is supportive care Examples of antidotes: Digoxin-specific antibodies Atropine & 2-PAM N-acetylcysteine Antidotes:

More Related