Workshop, Toxicology

بسم الله الرحمن الرحيم

PRINCIPLES OF

POISONING

MANAGEMENT

Tanta poison center

Address: Emergency hospital, Faculty of medicine, Tanta .

Telephone: 0185103132Administrative line : 3350373

Website :http://www.facebook.com/#!/home.php?sk=group_158174004241467

http://www.tanta.edu.eg/ar/medicine1/FMCT/ctu/index.html

تعارف

تعالوا نتفق األول

االبتسامة

األسئلة المنظمة

المحمول

الحوارات الجانبية

الهدف العام

و بالمعارفتزويد المتدربين الالزمة االتجاهات و المهارات

للتعامل مع حاالت التسمم

Program

1.Lecture

2.Case solving & Competition

3.Evaluation of the workshop

4.Transfer training

Pre-Test

Role 1:

It is better to do NOTHING than to harm the patient.

Role 2:

All poisoned patients should be treated as potentially LIFE-

THREATENING CONDITIONS, even though if they appear not so ill.

؟؟.. ايه حتعمل طيب1- Primary survey:Rapid recognition of critical illness.

2- Resuscitation:Airway, Breathing, Circulation, Coma,

Convulsions

3- Secondary survey:History, examination & investigations.

4- Definitive care and monitoring:

1. Decontamination

2. Specific Antidotes

3. Enhancement of Elimination

4. Symptomatic treatment

SnakeCo

Corrosives

Hydrocarbons

O.P

Home First Aid For Common Poisons

Coma

Diagnosis Of Poisoning

Physical Examination

Toxidromes Types & Examples D.D. Importance

Investigations Laboratory Radiologic

HistoryBenefits

& Problem

DIAGNOSIS OF POISONING

History:

Benefits

&

Problem

Circumstantial evidences

Sudden appearance of toxic manifestations in a group of persons after taking certain food or drink.

Presence of bottle of tablets or insecticide near the victim.

Presence of suicidal note.

Prof Dr Ashraf M. Emara

History

Prof Dr Ashraf M. Emara

Important history

Which Poisons were ingested?

- Coingestants (ethanol, BZD, TCA)

- Drug formulations (-SR)What amount was ingested?When were the drugs ingested?Accidental vs. intentional?

Personal history

Prof Dr Ashraf M. Emara

Name IdentificationReassuranceFollow up

Prof Dr Ashraf M. Emara

Age

Infant, child and old age more risky to poisoning.

Prof Dr Ashraf M. Emara

Age of the person

08/04/23 Prof Dr Ashraf M. Emara

Sex

Females are more risky to poisoning than males.

Prof Dr Ashraf M. Emara

Residence

Persons are housing near source of pollution .

Prof Dr Ashraf M. Emara

Occupation

Workers: occupational exposure.

Prof Dr Ashraf M. Emara

Marital state

Divorced womenFailure in Exam or love

7-1-2010 Prof Dr Ashraf M. Emara

Special habits

SmokingAddiction

Prof Dr Ashraf M. Emara

Socioeconomic state

Low standard

Prof Dr Ashraf M. Emara

Toxicological history

Amount:Frequency:Period of exposure:Form:Time passed since administration:

Prof Dr Ashraf M. Emara

Past history

Pervious history of poisoning.Pervious attempts of suicide.Any medical diseases (kidney, liver).Any surgical operation (gastric).

Prof Dr Ashraf M. Emara

Family history

Congenital disease (glucose 6 phosphate dehydrogenase deficiency).

Prof Dr Ashraf M. Emara

Complaint

It taking by patient's own wards (try to avoid medical terms) or from relatives in case of disturbed consciousness.

Prof Dr Ashraf M. Emara

AVOID medical terms:

Bluish discoloration of skin not Cyanosis

Coughing of blood not Haemoptysis

Vomiting of blood not Haematemsis

AVOID leading questions e.g.

No chest pain

No vomiting

08/04/23 Prof Dr Ashraf M. Emara

Present history

Prof Dr Ashraf M. Emara

Onset:Acute, Chronic

Duration: (when were your last quite well).Course: (progressive, regressive, stationary).

Prof Dr Ashraf M. Emara

Physical examination

Any patient presented by multi-system affection should be considered as a case of poisoning till proved otherwise.

Toxidromes

A group of S&S pointing to …..

Cholinergic Syndrome

DUMBELS Defecation Urination Miosis Bronchospasm, Bronchorrhea, Bradycardia Emesis Lacrimation Salivation, Sweating

SLUDGE Salivation Lacrimation Urination Diaphoresis GI upset Emesis

Cholinergic Syndrome

Examples:

Organophosphates Carbamates Pilocarpine

Anticholinergic Syndrome

ABCDE Agitation & hallucinations Blurred vision & mydriasis Convulsions Dryness (skin, constipation, urine retention) Elevated temperature & heart rate

Anticholinergic Syndrome

)DRY as a bone ( Dry skin

)RED as a beet ( Flushed

)HOT as a hare ( Hyperthermia

(BLIND as a bat) Dilated pupils

Anticholinergic Syndrome

(MAD as a hatter)Hallucinations

(Flappy as a bird)

Tachycardia

(Full as Container) Urinary retention

Anticholinergic Syndrome

Examples:

Atropine Antihistamines Benztropine Cyclic Antidepressants

Sympathomimetic Syndrome MATHS

MydriasisAgitationTachycardiaHypertension -

HyperthermiaSeizures - Sweating

Sympathomimetic Syndrome

Mimics Anticholinergic except WET compared to dry; Sweating Defecation.

Examples:

Cocaine Amphetamines Phencyclidine Pseudoephedrine

Opioid Syndrome (CPR) Triad of:

Consciousness: depressedPupils: pinpointRespiration: depressed

Also see: Decreased blood pressure Decreased temperature Decreased reflexes

Examples:

Heroin Morphine Codeine Methadone

Importance:

Faster diagnosis Faster initiation of therapy.

The patient presentation may be

atypical:

- Delay - Multiple

InvestigationsInvestigations

Laboratory Radiology

Quiz..…

مجموعة جائزة ألولصح تجاوب

Name the toxidrome

A 17 year old male with a history of behavioral problems at school presents to the emergency department after a suicide attempt. He was noted to be hallucinating earlier, and had a convulsion prior to arrival.

Physical Examination: Arousable to loud verbal stimulus. He moves his extremities

spontaneously. Pulse: 120 RR: 20 BP: 125/80 Temp: 40 Pupils: Dilated & Fixed Lungs: NAD Abdomen: Markedly decreased bowel sounds, fullness in the

suprapubic area Skin: Slightly flushed, dry Neuro: hyperreflexia

Toxidrome

Anticholinergic

Case Study

An 18-year-old man presented to the hospital 4 hours after insecticide spaying. He complained of abdominal pain, appeared lethargic, weak, and had vomited at least once. His vital signs were notable for a heart rate of 60 beats/min, Bl pr 90/60 mmHg, and a respiratory rate of 30 breaths/ min with frothy secretions from the mouth and nose. The pupils were constricted.

إيه دى ☻الحاله

Cholinergic Toxidrom

Organophosphates

Ahmad El-Ebiary

كفااااااااااااااااااية

Take home message

Take home message

Suspect poisoning if multisystem involvement.

Treat the patient not the poison.

Consider contraindications & complications before an action.

Dispose off the patient properly.

Consider psychiatric care.

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