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Summary of Lecture
General Principles in the Management of ANY Poisoning Specific management options with certain substances
Paracetamol Opiates (Heroin, Methadone, Morphine) Salicylates (Aspirin) Tricyclic Antidepressants (e.g Dothiepin)
General Management -1
A (Airway) B (Breathing) C (Circulation) D (Disability-AVPU/ Glasgow Coma Scale) DEFG ( Dont ever forget the Glucose) GET A SET OF BASIC OBSERVATIONS
General Management -2
Use all your senses, search for the clues LOOK
Track Marks Pupil Size
FEEL
Temperature, Sweating
SMELL
Alcohol
Haemodialysis (Aspirin)
Paracetamol-Normal Metabolism
Paracetamol converted to: N-Acetyl-p-benzoquinonamine (TOXIC) This is conjugated with Glutathione Glutathione stored in the body Produces a NON TOXIC metabolite
Paracetamol Overdosemanagement
Initial ABC ( usually well systemically) Get a good history
TIME TAKEN, AMOUNT Any other medication History of Liver disease
N - Acetylcysteine
Specific antidote used for Paracetamol Provides the Sulphydryl groups needed to increase the availability of Glutathione So that Body can turn the TOXIC metabolite into the non toxic form and prevent Liver Cell Damage and NECROSIS Problem: Not shown to be effective after 15 hours
Paracetamol Management
Able to measure levels of Paracetamol in the blood. Helps to guide whether amount taken is enough to be Hepatotoxic IF IN DOUBT start treatment before the Paracetamol levels get back to save time
Paracetamol Management-Pitfalls
Patients with Liver Disease/ Alcoholics
Depleted stores of Glutathione will start to get toxic build up sooner than healthy people
Staggered Overdoses
Levels unreliable
Paracetamol Management
TIMEBOMB WAITING TO HAPPEN IF HAVE LATE PRESENTATION HAVE TO MONITOR FOR IMPENDING LIVER FAILURE REFER TO SPECIALIST LIVER UNIT PEOPLE DIE FROM THIS
Opiate Overdose-Management
INITIAL MANAGEMENT A B C D
Opiate Overdose-Management 2
NALOXONE
Opioid antagonist High Affinity for the opiate receptors Little other effects Rapid onset Effects last 2-4 hrs, may need repeated doses Give I-M or I-V
2. Metabolic Acidosis
UNCOMMON FEATURES:
Confusion, Disorientation, Coma, Convulsions Haematemesis, Hyperpyrexia, clotting abnormalities, renal failure
Aspirin Overdose-Management
Initial Supportive therapy. If small amounts and asymptomatic may need no treatment Management tailored according to the amount taken Able to take Salicylate levels to help guide treatment options
Gastric Lavage
May be considered in those who have taken more than 500mg/kg body less than 1 hour ago. Steps must be taken to protect the airway
Tricyclic Antidepressants
Seen relatively frequently Can be fatal Can be very symptomatic, effects made worse by alcohol Main effects are on the Heart and Brain Effects are
1. Anticholinergic 2. Quinidine like
Correct Hypoxia with Oxygen Correct Acidosis with Na Bic Correct any arrythmias with Na Bic (i.e start by controlling the acid base disturbance)
QUESTIONS
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SUMMARY
Get as much history as you can, know your enemy Mainstay of any poisoning is Supportive Dont Forget the ABC For specific substances there maybe antidotes For Specific circumstances consider decreasing the absorption or increasing the elimination of the drug.