Treatment of specific poisons
Organophosphate compounds
Cholinergic signs: DUMBELS:
Defecation,
Urination,
Miosis,
Bronchorrhea/Bronchospasm/Bradycardia,
Emesis,
Lacrimation,
Salivation.
Also, fasciculations, muscle weakness and paralysis
- Get rid of poison
- Eyes (irrigation)
- Skin (remove clothing) and bathe
- Specific treatment
- Atropine 20 micrograms/kg IV or IM every 15 min until secretions have stopped and the chest is dry
- Monitor regularly (respiratory rate, coma score, heart rate, secretions) e.g. every 15 minutes initially, then every 30 minutes
- Assisted ventilation if necessary
Local medicines
Usually taken for diarrhoea and vomiting.
May lead to acidosis, respiratory distress, paralytic ileus.
- Rehydration i.e. give IV fluids and glucose
- Pass an NGT and leave on free drainage
Petroleum compounds (Paraffin)
Frequently presents with features of respiratory distress.
May cause pneumonitis, pneumomediastinum, pneumothorax and subcutaneous
emphysema.
- Do not induce vomiting
- Give oxygen if necessary
- Chest x-ray if symptomatic
- Antibiotic therapy may be needed for secondary chest infections
Carbon monoxide poisoning
Toxic effects are due to hypoxia.
Oxygen saturations can be misleading.
Poisonous plants
Usually only small quantities are ingested
- Mainly supportive and activate charcoal if available
Bleach
- Liberal fluids and milk
- Do not induce vomiting
Snake bite
- Check for fang marks, note if scarifications present or not
- Look for evidence of use of a tourniquet
- Ask about time of bite
- Check bitten limb for swelling, pulses, colour and viability
- Check for systemic evidence of envenoming - fever, altered coma score, shock, anaemia
- Mark with a pen, the level of swelling on a limb so that further swelling can be assessed
Management
- ABC
- FBC and diff, blood culture and blood clotting time (see how long it takes for blood to clot in a plain tube)
- Group and cross match and hold blood unless anaemic
- Place an IV infusion of normal saline
- Check that tetanus toxid immunisation is up to date; if not give it. Immunisation protocol
If local swelling is marked or there is evidence of systemic envenoming:
- Inform senior. Anti snake venom will be required
- Give 40mls in 200mls of normal saline IV over 1hr but have adenaline standing by: anaphylactic reactions are not uncommon.
- If circulation is threatened inform the surgical team on call as compartment syndrome may need fasciotomy.
- Treat pain appropriately - morphine may be needed
Iron poisoning
- Gastrointestinal (GI) phase: 30 minutes to 6 hours after ingestion
- Latent, or relative stability, phase: 6 to 24 hours after ingestion
- Shock and metabolic acidosis: 6 to 72 hours after ingestion
- Hepatotoxicity/hepatic necrosis: 12 to 96 hours after ingestion
- Bowel obstruction: 2 to 8 weeks after ingestion
- Supportive therapy to maintain adequate blood pressure and electrolyte balance is
essential
- I.V. fluid resuscitation
- May need potassium and glucose supplementation
- Consider desferrioxamine 15mg/kg/hr I.V. if available
- If oliguria or anuria develop, take sample for U&E, monitor BP, catheterise
andconsider peritoneal dialysis
Salicylate overdose
Presents with tachypnoea, metabolic acidosis, and to a lesser extent, tachycardia.
Early symptoms include tinnitus, vertigo, nausea, vomiting, and diarrhoea.
More severe intoxication can cause fever, altered mental status, coma, non-cardiogenic
pulmonary oedema, and death.
- ABC
- Administer multiple doses of activated charcoal (first dose: 1 g/kg orally up to 50 g)
- Administer supplemental glucose in patients with altered mental status, even if serum glucose concentration is normal: IV dextrose 50 g as 100 mL of 50 percent dextrose
- Send U&E and RBS
- Correct electrolyte abnormalities
- Consider peritoneal dialysis