Management of Poisoning.ppt

Basics of Poison Management – promoting poison removal Pro’s and con’s of Ipecac FDA slideshow on Ipecac Must be conscious No petroleum distillates or caustic products Only 25% of gastric contents Gastric lavage May be unconscious Won’t get large pills Basics of Poison Management – preventing further absorption Activated charcoal Binds to many chemicals, preventing absorption May bind to antidotes Challenging to adminster – a black slurry Use styrofoam cup with lid and straw Another FDA view of the subject Further research is still needed, but right now, Ipecac is still OTC (according to ePocrates) Management of Poisoning Accidental or otherwise… Case #1 You find a friend passed out on the bathroom floor. You see a pill bottle near by. What do you do? On arrival to the hospital, what do you expect them to do? Basics of Poison Management Support physiological functions (airway, respiration, circulation) Poison identification Promotion of poison removal Ipecac? Gastric lavage? Prevention of further absorption Activated charcoal? Use of specific antidotes Case #2 An alcoholic resorts to drinking ethylene glycol. He presents with the following lab results: pH=7.26, PaCO2=26 mmHg, HCO3-=16 mEq/L BUN = 60 mg/dL, Cr = 2.5 mg/dL K+ = 6.0 mg/dL, Ca + + = 7.1 mg/dL What are your priorities? Fomepizole (Antizol) Sodium bicarbonate to alkalinize urine, ↑ excretion Antidotes Toxic substance Antidote Bethanechol (Parasympathomimetic), Neostigmine (cholinesterase inhibitor) Atropine Atropine (Anticholinergic) Physostigmine Morphine (Opiods) Naloxone (Narcan) Valium (diazepam), Ativan (lorazepam), Versed (midolazam) - (benzodiazepines) Flumazenil (Romazicon) Digoxin Digoxin immune Fab (Digibind) Warfarin (Coumadin) Vitamin K Heparin Protamine sulfate Insulin induced hypoglycemia Glucagon Acetaminophen Acetylcysteine (Mucomyst) Case #3 A young child sees his grandma take some “MMs”. When grandma takes a nap, the 4 year old decides to help himself. Grandma is being treated