GENERAL MEASURES CONSIDER

·       Potency

·       Quantity

·       Duration of exposure

·       Presence of other ingredients, i.e. co-ingestants

·       Early identification of toxin

·       Risk factors

·       Exclude hypoglecemia/other metabolic defects

·       ECG monitoring

FEATURES CLUSTERS FOR LIKELY POISONS

CLINICAL FEATURES: Coma, hypertonia, hyperreflexia, extensor plantar, Dry mouth, myoclonus, strabismus, mydriasis, sinus

Tachycardia, urinary retention

LIKELY POISONS: Tricyclic antidepressants

CLINICAL FEATURES: Coma, hypotonia, hyporeflexia, non-excitable Plantar response,hypotension

LIKELY POISONS: Barbiturates, Benzodiazapines And alcohol combinations

CLINICAL FEATURES: Coma, miosis, reduced respiratory rate

LIKELY POISONS: Opiod analgesics

CLINICAL FEATURES: Nausea, vomiting, tinnitus, deafness, sweating, Hyperventilation, tachycardia

LIKELY POISONS: Salicylates

CLINICAL FEATURES: Restlessness, agitation, mydriasis, anxiety tremor, Tarchycardia, convulsions

LIKELY POISONS: Sympathomimetics

CLINICAL FEATURES: Parasympathetic activity like abdominal cramps,diarrhoea, Salivation, flaccid paralysis of limb, respiratory and ocular Muscles in various degrees, miosis, repiratory failure(typeII), ‘kerosene’smell

LIKELY POISONS: Carbamates, Organophosphates, Pesticides, herbicides

PRIMARY CARE

 Like any critically ill patient with some exeptions: ‘ABCDEFGH’ AIRWAY: Assess AIRWAY for obstruction; Insert oropharryngeal airway; Nurse in semi-prone position

BREATHING: Assisted ventilation with oxygen, AVOID HYPOVENTILATION CIRCULATION: Establish venous access; Avoid HYPOTENSION.

Decontamination: Remove from the site if gaseous poison, wash body surface or remove clothing if Organophosphorus poisoning.

Drugs:

Antidotes:

Multidose activated charcoal: Do not give if bowels sounds are absent/in corrosive poisoning. Not effective in metal poisonings. Multidose regimes 1-2 gm/kg q 4 hourly. Airway should be protected if patients is unconscious. 70% sorbitol as an osmotic cathartic.

Specific : Flumazenil, Atropine Naloxone.

ELECTROLYTES/ECG: Correct dys-electrolytemias; Na, K, Creatinine. ECG monitoring for earlyRecognition and treatment of fatal arrhythmias.

FLUID BALANCE: Catheterize, Intake-output chart, IV fluids, Central venous line if haemodynamicallyunstable. Keep urine output high (>100-150 ml/hour)

GAVAGE: Gastric lavage/stomach wash-

Indications :- any unknown poison ingested; duration of ingestion not known; even when period of ingestion is > 4hrs. still worthwhile in certain poisons where gastric emptying is delayed.

Caution:- in comatose patients with ET tube in place

Contraindication :- corrosives, volatile hydrocarbons should be followed by activated charcoal.

HAEMODIALYSIS : If indicated

Psychiatric assessment and support, once patient is stablilised.