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POISONING AND HANGING

POISONING AND HANGING. DR. SAURABH CHITTORA Assistant professor Department of gen. Medicine New hospital, GMC , KOTA.

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POISONING AND HANGING

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  1. POISONING AND HANGING DR. SAURABH CHITTORA Assistant professor Department of gen. Medicine New hospital, GMC , KOTA

  2. Any unconscious patient arriving in Emergency should be turned to lie on one side to stop the tongue blocking in the throat and to allow the fluid/saliva come out of the mouth – RECOVERY POSITION Management of poisoning (General Considerations)

  3. Airway – open and clean the airway. head tilt and chin lift • Breathing-Maintain O2 saturation. Use venti-mask with high flow Oxygen supplementation • Circulation – Immediately secure IV line and give fluid (DNS/RL) Immediate resuscitative measures

  4. Inhaled poison - Increase ventilation by supplemental oxygen therapy @5-6 lt/min • Contact poison - Remove clothes. Saline irrigation of eyes. • Ingested poison - Gastric lavage REMOVAL OF UNABSORBED POISON FROM THE BODY

  5. Corrosive poisoning • Unconcious patient • Volatile poisons viz. Kerosene • Known case of Esophagealvarices • Marked hypothermia • Bleeding disorders • Convulsant poisons CONTRAINDICATIONS OF GASTRIC LAVAGE

  6. Mechanical or physical antidotes – • activated charcoal • Demulcents • Bulky foods • Chemical antidote • Common salt – silver • Albumin/milk – mercury • Dialysed Iron – arsenic • Copper sulfate – phosphorus • KMnO4- opium, strychnine, cyanide • Physiological antidote – • Atropine- OPC poisoing Administration of antidotes

  7. Indications :- • Severe poisoning. • Progressive deterioration of patient condition. • When normal route of excretion of toxic substance is impaired. • Renal excretion • Purging – sorbitol 50 ml • Whole bowel irrigation - • Forced alkaline diuretics • Hemodialysis Elimination of poison by excretion

  8. Chemicals- malathion, parathion, chlorthion • Identification- SLUDGE, Muscle faciculations, restlessness irritability, tremors, seizures • Treatment- • removal of clothes to prevent further exposure from unabsorbed poison. • Gastric lavage with 1:5000 KMnO4 • Physiological antidote- atropine 2-4mg stat. • Chemical antidote – PAM 2gm stat ….. < 12 gm /day ORGANOPHOSPHOROUS POISONING

  9. Chemical- DDT, BHC, Lindane, aldrin, dieldrin, mirex • Identification- NV, restlessness, N/dilated pupils • Treatment- gastric lavage with activated charcoal, give oral cholestyramine 16gm/day for 7 days. Organochlorines poisoning

  10. Chemicals- barium carbonate • Identification- NVD, Areflexia, paralysis, cardiac arrest • Treatment- gastric lavage and bowel wash/purging Rat killer poison

  11. Chemical- aluminium phosphide • Identification- garlic odour, NVD, hypotension, pulmonary edema • Treatment- Gastric lavage with kmno4 Antacids Liquid paraffin Magnesium sulphate 1gm1-1.5gm 6hrly for 5-7 days infusion Dopamine IV hydrocortisone sodabicarbonate Celphos poisoning

  12. Chemical – HCL (Tezaab) • Identification - coughing, cyanosis, hemetemesis • Treatment – Gastric lavage is contraindicated Paste of MOM is applied IV hydrocortisone IV fluids Acid ingestion

  13. Chemical – ethyl alcohol • Identification – excitability, incoordination, coma • Treatment – Gastric lavage 10% dextrose in 1lt with 15 units regular insulin 100mg thiamine Oxygen Alcohol overdose

  14. HANGING

  15. Loss of power • Loss of sensations • Loss of conciousness (within 15 sec) • Stage of convulsion • Cessation of respiration • Cessation of heart beat • Fatal period is 2-5 mins Sequence of events

  16. Trachea – 15 kg • Jugular veins – 2 kg • Carotid artery – 4-5 kg • Vertebral artery – 20 kg

  17. Secure airway – endotracheal intubation • High flow O2 therapy- reverse cerebral anoxia • Neck stabilization – hard cervical collar, cervical cushion • IV hydrocortisone – cord edema • Maintain blood pressure • Early detection of arrhythmias.

  18. Thank you

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