logging in or signing up Poisoning Overdose aSGuest1049 Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINT lite Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: (To copy code, click on the text box) Embed: URL: Thumbnail: WordPress Embed Customize Embed The presentation is successfully added In Your Favorites. Views: 3010 Category: News & Reports.. License: All Rights Reserved Like it (0) Dislike it (0) Added: October 15, 2008 This Presentation is Public Favorites: 1 Presentation Description No description available. Comments Posting comment... By: cute.prakti (18 month(s) ago) thanx..................................it helps me alot during my presentation Saving..... Post Reply Close Saving..... Edit Comment Close By: mesooo (31 month(s) ago) thanxxxxxxxxxxx alot its really peneficial Saving..... Post Reply Close Saving..... Edit Comment Close Premium member Presentation Transcript Poisoning/Overdose : Poisoning/Overdose General Management Poisoning : Poisoning Exposure to substance that is toxic in any amount Overdose : Overdose Exposure to substance in excess amount resulting in toxic effects 1998 TESS Data : 1998 TESS Data 2,241,082 reported human exposures 97.9 % at home Peak volume 4pm-10pm 91% of calls 8am-midnight Exposures by Age : Exposures by Age < 6 years old 52.7% < 3 years old 39.6% Fatalities : Fatalities 775 fatalities 0.03% of total exposures ages 20 - 49 years = 56% >6 years = 2.1% Number of Substances : Number of Substances 92.8% of all cases--one substance 44.7% of fatal cases-->2 substances Management Location : Management Location Managed on site 75.2% Treated, released at ER 12.3% Admitted to critical care 2.7% Refused referral 2.0% Therapy : Therapy No therapy 11.9% Observation only 12.7% Decontamination only 59.6% Activated charcoal 6.8% Ipecac 1.2% Most Common Substances : Most Common Substances Cleaning substances 10.2% Analgesics 9.6% Cosmetics 9.4% Plants 5.5% Foreign bodies 4.6% Cough, cold 4.5% Bites, stings 4.1% Most Common Substances : Most Common Substances Insecticides, pesticides, rodenticides 3.9% Sedative, hypnotics, antipsychotics 3.2% Antidepressants 3.0% Hydrocarbons 3.0% Alcohols 2.5% Largest Number of Deaths : Largest Number of Deaths Analgesics 264 Antidepressants 152 Stimulants, street drugs 118 Cardiovascular medication 118 Sedatives, hypnotics 89 Alcohols 56 Indicators : Indicators Sudden onset of CNS signs: Seizures Coma Decreased LOC Bizarre behavior Indicators : Indicators Sudden onset of: Abdominal pain Nausea Vomiting Indicators : Indicators Sudden onset of unexplained illness Bizarre, incomplete, evasive history Trauma (>50% of adult trauma EtOH, drug-related) Pediatric patient with arrhythmias History : History What? How much? How long? Multiple substances? Treatment attempted? How? Whose advice? Psychiatric history? History of suicide? General Management : General Management Support ABC’s Secure airway, intubate as needed Ensure adequate oxygenation, ventilation Maintain adequate circulation Monitor ECG Obtain vascular access Manage hypotension initially with volume Use vasopressors cautiously General Management : General Management Keep patient calm Maintain normal body temperature Evaluate nature/toxicity of poison Check container, package insert, poison center information Treat the patient, not the poison General Management : General Management Rule out Trauma Neurological disease Metabolic disease Base general management on route of poison entry Poison Entry : Poison Entry Ingestion Slow movement from injection site throughout body Remove from skin surface Remove from exposure; Support oxygenation, ventilation Prevent absorption from GI tract Inhalation Absorption Injection Ingested Poisons : Ingested Poisons Objective Remove from GI tract before absorption occurs Ipecac : Ipecac RARELY used anymore If used, has to have been initiated within few minutes after ingestion Vomiting in 20-30 minutes Only removes about 32% of contaminate Many contraindications Ipecac : Ipecac Dose 15 cc if 12 months to 12 years old 30 cc if >12 years old Follow with 2-3 glasses of water Keep patient ambulatory if possible Ipecac : Ipecac If no vomiting after 20 minutes, repeat When emesis occurs, keep head down Collect, save vomitus for analysis Ipecac : Ipecac Contraindications Comatose or no gag reflex Seizing or has seized Caustic (acid or alkali) ingestion Low viscosity hydrocarbon ingestion Late term pregnancy Ipecac : Ipecac Contraindications Severe hypertension, cardiovascular insufficiency, possible AMI Ingestion of: Strychnine Phenothiazines (Thorazine, Stellazine, Compazine) Tricyclic antidepressants Iodides Silver Nitrate Lavage : Lavage Commonly used in ED’s Removes about 31% of substance Helps get activated charcoal in patient, especially if patient is unconscious Not helpful for sustained release tablets Will not remove large tablets Activated Charcoal : Activated Charcoal Adsorbs compounds, prevents movement from GI tract Very effective at adsorbing substances Binds about 62% of toxin Dose 5 - 10X estimated weight of ingested chemical Activated Charcoal : Activated Charcoal Inactivates Ipecac Do not give until vomiting stops Do not give with Cyanide Methanol Tylenol (+) Containers must be kept airtight Inhaled Poisons : Inhaled Poisons Objective: Move to fresh air; optimize ventilation and protect personnel from exposure Absorbed Poisons : Absorbed Poisons Objective: Remove poison from skin Liquid: Wash with copious amounts of water Powder: Brush off as much as possible, then wash with copious amounts of water Protect personnel from exposure Dilute / Irrigate / Wash : Dilute / Irrigate / Wash Use soap, shampoo for hydrocarbons No need for chemical neutralization - heat produced by reaction could be harmful Eye Irrigation : Eye Irrigation Wash for 15 minutes Use only water or balanced salt solutions Remove contact lenses Wash from medial to lateral You do not have the permission to view this presentation. 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Poisoning Overdose aSGuest1049 Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINT lite Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: (To copy code, click on the text box) Embed: URL: Thumbnail: WordPress Embed Customize Embed The presentation is successfully added In Your Favorites. Views: 3010 Category: News & Reports.. License: All Rights Reserved Like it (0) Dislike it (0) Added: October 15, 2008 This Presentation is Public Favorites: 1 Presentation Description No description available. Comments Posting comment... By: cute.prakti (18 month(s) ago) thanx..................................it helps me alot during my presentation Saving..... Post Reply Close Saving..... Edit Comment Close By: mesooo (31 month(s) ago) thanxxxxxxxxxxx alot its really peneficial Saving..... Post Reply Close Saving..... Edit Comment Close Premium member Presentation Transcript Poisoning/Overdose : Poisoning/Overdose General Management Poisoning : Poisoning Exposure to substance that is toxic in any amount Overdose : Overdose Exposure to substance in excess amount resulting in toxic effects 1998 TESS Data : 1998 TESS Data 2,241,082 reported human exposures 97.9 % at home Peak volume 4pm-10pm 91% of calls 8am-midnight Exposures by Age : Exposures by Age < 6 years old 52.7% < 3 years old 39.6% Fatalities : Fatalities 775 fatalities 0.03% of total exposures ages 20 - 49 years = 56% >6 years = 2.1% Number of Substances : Number of Substances 92.8% of all cases--one substance 44.7% of fatal cases-->2 substances Management Location : Management Location Managed on site 75.2% Treated, released at ER 12.3% Admitted to critical care 2.7% Refused referral 2.0% Therapy : Therapy No therapy 11.9% Observation only 12.7% Decontamination only 59.6% Activated charcoal 6.8% Ipecac 1.2% Most Common Substances : Most Common Substances Cleaning substances 10.2% Analgesics 9.6% Cosmetics 9.4% Plants 5.5% Foreign bodies 4.6% Cough, cold 4.5% Bites, stings 4.1% Most Common Substances : Most Common Substances Insecticides, pesticides, rodenticides 3.9% Sedative, hypnotics, antipsychotics 3.2% Antidepressants 3.0% Hydrocarbons 3.0% Alcohols 2.5% Largest Number of Deaths : Largest Number of Deaths Analgesics 264 Antidepressants 152 Stimulants, street drugs 118 Cardiovascular medication 118 Sedatives, hypnotics 89 Alcohols 56 Indicators : Indicators Sudden onset of CNS signs: Seizures Coma Decreased LOC Bizarre behavior Indicators : Indicators Sudden onset of: Abdominal pain Nausea Vomiting Indicators : Indicators Sudden onset of unexplained illness Bizarre, incomplete, evasive history Trauma (>50% of adult trauma EtOH, drug-related) Pediatric patient with arrhythmias History : History What? How much? How long? Multiple substances? Treatment attempted? How? Whose advice? Psychiatric history? History of suicide? General Management : General Management Support ABC’s Secure airway, intubate as needed Ensure adequate oxygenation, ventilation Maintain adequate circulation Monitor ECG Obtain vascular access Manage hypotension initially with volume Use vasopressors cautiously General Management : General Management Keep patient calm Maintain normal body temperature Evaluate nature/toxicity of poison Check container, package insert, poison center information Treat the patient, not the poison General Management : General Management Rule out Trauma Neurological disease Metabolic disease Base general management on route of poison entry Poison Entry : Poison Entry Ingestion Slow movement from injection site throughout body Remove from skin surface Remove from exposure; Support oxygenation, ventilation Prevent absorption from GI tract Inhalation Absorption Injection Ingested Poisons : Ingested Poisons Objective Remove from GI tract before absorption occurs Ipecac : Ipecac RARELY used anymore If used, has to have been initiated within few minutes after ingestion Vomiting in 20-30 minutes Only removes about 32% of contaminate Many contraindications Ipecac : Ipecac Dose 15 cc if 12 months to 12 years old 30 cc if >12 years old Follow with 2-3 glasses of water Keep patient ambulatory if possible Ipecac : Ipecac If no vomiting after 20 minutes, repeat When emesis occurs, keep head down Collect, save vomitus for analysis Ipecac : Ipecac Contraindications Comatose or no gag reflex Seizing or has seized Caustic (acid or alkali) ingestion Low viscosity hydrocarbon ingestion Late term pregnancy Ipecac : Ipecac Contraindications Severe hypertension, cardiovascular insufficiency, possible AMI Ingestion of: Strychnine Phenothiazines (Thorazine, Stellazine, Compazine) Tricyclic antidepressants Iodides Silver Nitrate Lavage : Lavage Commonly used in ED’s Removes about 31% of substance Helps get activated charcoal in patient, especially if patient is unconscious Not helpful for sustained release tablets Will not remove large tablets Activated Charcoal : Activated Charcoal Adsorbs compounds, prevents movement from GI tract Very effective at adsorbing substances Binds about 62% of toxin Dose 5 - 10X estimated weight of ingested chemical Activated Charcoal : Activated Charcoal Inactivates Ipecac Do not give until vomiting stops Do not give with Cyanide Methanol Tylenol (+) Containers must be kept airtight Inhaled Poisons : Inhaled Poisons Objective: Move to fresh air; optimize ventilation and protect personnel from exposure Absorbed Poisons : Absorbed Poisons Objective: Remove poison from skin Liquid: Wash with copious amounts of water Powder: Brush off as much as possible, then wash with copious amounts of water Protect personnel from exposure Dilute / Irrigate / Wash : Dilute / Irrigate / Wash Use soap, shampoo for hydrocarbons No need for chemical neutralization - heat produced by reaction could be harmful Eye Irrigation : Eye Irrigation Wash for 15 minutes Use only water or balanced salt solutions Remove contact lenses Wash from medial to lateral