Professional Documents
Culture Documents
Management of
Poisoned
Patients
PWM OLLY INDRAJANI
2013
Introduction
Resuscitation
The first priority in treating poisoned patients
ED Diagnosis History
It is often
Toxidromes
Toxicologic Screen
In
positive
Negative
results
results
Interpretation
Positive
resultsofmay
urine
occur
toxicology
with many
screening
substances
test results
because
requires
they persist
an un
General Decontamination
The general approach to most toxic
exposures the removal of the
patient from the substance and the
substance from the patient.
Toxins on the outside of the body
washed away.
Toxins within the body, either bound
within the gut lumen to make it
unavailable for absorption or
elimination from the gut, blood, or
tissues can be enhanced.
Gross Decontamination
GI Decontamination
Gastric Emptying
Orogastric Lavage
Multidose
Whole-Bowel Irrigation
Whole-bowel irrigation is best accomplished by
infusing the polyethylene glycol solution through a
nasogastric tube, although in motivated patients,
oral ingestion can be used. Typical doses are 1.5 to
2.0 L/h in adults, 1 L/h in children 6 to 12 years of
age, and 0.5 L/h in children <6 years of age.
Contraindications include preceding diarrhea,
ingestion of substances that are expected to result
in significant diarrhea (except for heavy metals,
because these substances do not adsorb well to
activated charcoal), and bowel obstruction as
evidenced by lack of bowel sounds.
Complications include bloating, cramping, and
rectal irritation from frequent bowel movements.
Urinary Acidification
The benefits include the ability to remove toxins that have already been absorbed from