POISONING AND DRUG OVERDOSAGE Department of Internal Medicine WAN Weiguo
POISONING AND DRUG OVERDOSAGE Department of Internal Medicine WAN Weiguo
General Info All chemicals have potential to be poisons if given a large enoug h dose Poisoning occurs when exposure to a substance adversely affects function of any organ system a3 factors toxicants i dose-related hazards to the body
General Info All chemicals have potential to be poisons if given a large enough dose Poisoning occurs when exposure to a substance adversely affects function of any organ system 3 factors toxicants ; dose-related ; hazards to the body
Definition Development of dose-related adverse effects Following exposure to chemicals, drugs, or other xenobiotics
Definition: Development of dose-related adverse effects following exposure to chemicals,drugs,or other xenobiotics
classification Chemicals fron: industrial、 medicine、 pesticide、 plants、 animals ● Organ or tissue involved: cardiovascular、 respiratory, nerve, liver, kidney blood Causation: occupational, daily life Onset: acute, subacute, chronic
classification Chemicals from：industrial、medicine、 pesticide、 plants、 animals Organ or tissue involved：cardiovascular、 respiratory, nerve, liver, kidney, blood Causation：occupational, daily life Onset：acute, subacute, chronic
Epidemiology More than 5 million toxic exposures reported in 2006 US each year Over half were children 6 yo Poisoning third leading cause of death from 1985-1995 Most are acute and accidental 5% require hospitalization Incidence of toxin related deaths increase 300%, Mortality 0.4%
Epidemiology More than 5 million toxic exposures reported in 2006 US each year Over half were children < 6 yo Poisoning third leading cause of death from 1985-1995 Most are acute and accidental 5% require hospitalization Incidence of toxin related deaths increase 300%, Mortality 0.4%
Resuscitation First priorities are abcs(air, breath, circulation) Vital sign including pulse oximetry and hypoglycemia must be corrected a Only in very rare incidences does administration of antidote precede stabilizing ABCs and vital signs pulse oximetry blood gas analysis)
Resuscitation First priorities are ABC’s(air,breath,circulation) Vital sign including pulse oximetry and hypoglycemia must be corrected Only in very rare incidences does administration of antidote precede stabilizing ABC’s and vital signs pulse oximetry(blood gas analysis)
Resuscitation Unresponsive pt' s treated empirically with coma cocktail Oxygen, naloxone, D50W, and 100mg thiamine 50 ml of d50W for adults and 1g/kg glucose for children(4ml/kg D25W or 10ml/kg of D10W) Thiamine not usually given to children a Glucose and thiamine should be given in timely manner however thiamine does not have to precede glucose to prevent Wernicke's (D50W=50% dextrose
Resuscitation Unresponsive pt’s treated empirically with coma cocktail Oxygen, naloxone, D50W, and 100mg thiamine 50 ml of D50W for adults and 1g/kg glucose for children (4ml/kg D25W or 10ml/kg of D10W) Thiamine not usually given to children Glucose and thiamine should be given in timely manner however thiamine does not have to precede glucose to prevent Wernicke’s (D50W=50% dextrose)
History Need to obtain as much info as possible about exposure Number of exposed persons, type of exposure amount or dose, route Pt's intent must be determined Info from pt's primary care physician witness or emt(mergency medical technican) helpful Check for empty bottles or containers, smells or unusual containers or suicide not
History Need to obtain as much info as possible about exposure Number of exposed persons, type of exposure, amount or dose, route Pt’s intent must be determined Info from pt’s primary care physician, witness or EMT(mergency medical technican) helpful Check for empty bottles or containers, smells or unusual containers, or suicide not
Physical Exam Undress pt completely for thorough exam Check clothing for objects or substances Assess general appearance of pt Agitation confusion, or obtundation Exam skin for bruising, cyanosis, flushing EXam eyes for pupIls SIze, nystagmus, reactivity dysconjugate gaze, increased acramation
Physical Exam Undress pt completely for thorough exam Check clothing for objects or substances Assess general appearance of pt Agitation, confusion, or obtundation Exam skin for bruising, cyanosis, flushing Exam eyes for pupils size, nystagmus, reactivity, dysconjugate gaze, increased lacramation
Physical Exam Oropharynx for increase salivation or excessive dryness Cardiovascular: rhythm, rate, regularity Lungs: bronchorrhea or wheezing Abd: bowel sounds, tenderness or rigidity Exterior fasiculations tremor Neuro: CN, reflexes, muscle tone coordination cognition ability to ambulate
Physical Exam Oropharynx for increase salivation or excessive dryness Cardiovascular: rhythm, rate, regularity Lungs: bronchorrhea or wheezing Abd: bowel sounds, tenderness or rigidity Exterior: fasiculations, tremor Neuro: CN, reflexes, muscle tone coordination, cognition, ability to ambulate