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Poisoning

 

 

 Routes of poisoning

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Inhaled- gases, dust, smoke, volatile solvents

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Injection  intravenous, intramuscular

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Application to wound

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Ingestion

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Application into natural orifice rectum, vagina, urethra

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Skin insecticides, nicotine, phenol, mercury

 

 Routes of elimination

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 Kidneys, skin, bile, milk, saliva, mucous and serous secretions

 

 Actions

 1. Local

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Destruction as by chemicals

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Inflammation, congestion

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Nerve stimulation-tingling

 

 2. Remote

 3. Combined

 

 Effect modified by

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Quantity

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Form-gases more dangerous

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Chemical combination-solubility

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Mechanical combination less if diluted with water

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Mode of administration-route

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Condition of body-age, reaction of body, habit,  state of health- sleep and intoxication-effect delayed if sleeps after poisoning

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Cumulative action

 

 Types

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Acute poisoning

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Chronic poisoning (Slow poisoning)

 

 Diagnosis

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History

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Symptoms-rapidly progress

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Same symptoms in many people

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Discovery of poison at site of poisoning, in vomitus, excreta

 

 Collection of samples

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Stomach wash

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Blood –10 ml

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Urine

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Faeces

 

 Lethal dose: is different for various poisons.

 

 Duties during first aid & treatment

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Care and treatment of patient.

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Help authorities.

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Collection of samples.

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Record of symptoms.

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Arrangements to shift to hospital.

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Preservation of suspected articles.

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Inform police.

 

 Poisons treatment

 

 Treatment

  1.  Removal of poisonous material from body.

  2.  Administration of antidote.

  3.  Elimination of poison by Excretion.

  4.  Symptomatic treatment.

 

 Removal of poisonous material from body

 

 1. Inhaled poisons

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Remove in to fresh air.

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Artificial respiration.

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Oxygen.

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Air passage kept free and open.

 

2. Injected poison-injection, bite

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Apply tight ligature immediately above wound.

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Loosen every 10 mts for 1 minute.

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Excise wound and suck out poison.

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Neutralize poison by chemical.

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Local vasoconstriction by injection of epinephrine.

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Locally dip in water 10 degree.

 

3. Contact poisons

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Washing with water

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Neutralize by specific chemical

                                                                          

                                                                                                Gastric lavage tube

4. Ingested poison

 

 A. Gastric lavage (to be done within 3 hrs)

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Done with stomach tube (ewald or boas tube) or

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Ordinary rubber tube of 1 cm diameter and 1.5 meter length with a glass funnel attached at one end. Ryle’s tube used for children and infants

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Warm water used, potassium per manganate 1:5000, 5% sodium bicarbonate, 4% tannic acid, 1% sod thiosulphate, 1% sod or pot iodide, 1-3% cal lactate, starch solu, saturated lime water.

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A small quantity of fluid containing antidote left

 Gastric lavage not to be done in cases of

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Corrosive poisons, Convulsants poisons, Comatose patients, Volatile poisons which can be inhaled.

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Esophageal varices.

 

  1. Emetics (Methods and drugs to induce vomiting)

 

 Requirements:  patient should be conscious

 Methods:

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Warm water.

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1 tablespoonful of mustard powder in water.

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2 tablespoon full of common salt in water.

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Zinc sulphate 1-2 grams in water.

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Ipecacuanha powder 1-2 gram or 30 ml.

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Ammonium carbonate 1-2 gram in water.

 

 Contraindications of emetics

  • As for gastric lavage.

  • Advanced pregnancy.

  • Heart and lung diseases.

 Poisons treatment

 

 Administration of antidote

 These are substances which counteract or neutralize effects of poisons

 

  1. Mechanical antidotes

  • Animal charcoal adsorbs and retains poison and delays absorption.

  • demulcents protective covering on mucosa- milk, starch, egg whites, mineral oils ,milk of magnesia, Aluminium hydroxide gel.

  • Bulky food

 2. Chemical antidotes

    Combine to form harmless or insoluble Compounds or by oxidation of poison 

  • Common salt destroys silver nitrate ( form silver chloride)

  • Albumen precipitates mercuric chloride

  • Dialyzed iron neutralize arsenic

  • Cuso4 precipitates phosphorus

  • Alkalies neutralize acids weak solution of an

  • Alkaline hydroxide, magnesia or ammonia used

  • Acids neutralize alkalies vinegar, lemon juice, fruit juice

  • Potassium permanganate acts by oxidizing (1:5000) cyanides, phosphorus

  • Tinc iodine , lugols iodine precipitates most alkaloids-mercury, lead, silver, quinine

  • Tannic acid 4% tannin (strong tea) – lead, silver, mercury, nickel

 3. When exact poison not known then, Universal antidote used.

  • Powdered animal charcoal ( burnt toast) 2 part

  • Magnesium oxide 1 part

  • Tannic acid or strong tea 1 part

  • A table spoon is mixed in a glassful of water and given by mouth

 4.  Physiological antidote

 

 4. Elimination of poison by excretion

  • Renal excretion- increase fluid intake, i/v fluids.

  • Purging -sodium sulphate and water.

  • Diaphoretics –application of heat, blankets.

  • Dialysis.

 

 5. Symptomatic treatment

 

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Treatment of symptoms of poisoning.

 

 

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