POISONING

PRESENTED BY: IVAN AVENADO

DEFINITION
Definition of Poisoning: Exposure to a chemical or other agent that adversely affects functioning of an organism. Circumstances of Exposure can be intentional, accidental, environmental, medicinal or recreational. Routes of exposure can be ingestion, injection, inhalation or cutaneous exposure.

SIGNS AND SYMPTOMS

Odor on the breath, such as the smell of gasoline A trace of the suspected toxin on the patient's clothes Symptoms like:
vomiting, difficulty breathing, sleepiness, or confusion.

Also look for burns or redness around the mouth and lips, which can result from drinking certain substances.

DIAGNOSTIC PROCEDURES
Pay close attention to arterial blood gases (ABGs) and blood glucose levels in a child with depressed consciousness, and continue to monitor vital signs. When there is incomplete or inaccurate information about what was ingested, the physical exam, laboratory tests, and a toxicological screen should be used to determine treatment.

Chest X-ray
Inhalation poisoning may show aspiration pneumonia.Petroleum distillate inhalation, they may show pulmonary infiltrates or edema. Abdominal x-rays may reveal iron pills or other radiopaque substances.

PATHOPHYSIOLOGY
Substance inhaled or ingested Extent of damage depends on the pH of the substance, the amount ingested, its form (solid or liquid), and the length of exposure to it Substance with alkaline pH cause tissue damage by liquefaction necrosis, which softens the tissue. Acid produce coagulation necrosis Coagulation necrosis denatures (changes the molecular composition of proteins when the substance contacts tissue Mechanism of action for inhalants are unknown Act on the CNs similarly to a very potent anesthetic Hydrocarbons sensitize the myocardial tissue and allow it to be sensitive to catecholamines Arrhythmias

Treatment
Initial treatment
Emergency resuscitation Support of the patients ABCs and prevention further poison absorption

Secondary treatment
Continuing supportive or symptomatic care and when possible administration of a specific antidote.

Prevent further absorption by administering activated charcoal, including emesis, or by administering gastric lavage and cathartics for specific treatment, contact the poison center.
The treatments effectiveness depends on the speed of absorption and the time elapsed between ingestion and removal.

Intravenous Therapy
Use large quantities of I.V. fluids to force the poison through the kidneys to be excreted. Kind of fluid you use depends on the patients acid-base balance and cardiovascular status and on the flow rate necessary for effective diuresis of poison. If ingested poisoning severe and requires peritoneal dialysis or hemodialysis, assist as necessary.

NSG MANAGEMENT
Assessment of the ABCs. Administer oxygen if the child shows signs of respiratory distress and initiate other emergency treatment as needed. Position the patient for comfort Monitor the I&Os Monitor the IV fluids given.