Workshop, Toxicology
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Transcript of 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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