Evaluation & Management of Poisoned ChildDone By:Hassan KhatibTarek Amoun

Routes Of Intake

Mouth

Inhalation Injection

Transdermal

INTAKE OF POISON MAY BE:

Accidental (mainly among toddlers)

Suicidal (mainly among adolescents)

Homicidal (may be attributed to child abuse)

DIAGNOSIS In the ER., you may be confronted with one of 2 situations:

1. Frank history of intake of a particular poison: The management will depend upon:

The Nature The Amount of poison The Time elapsed after its intake.

2. Denied or suspected history of poisoning: The cornerstone of management in this situation is:

Evaluation of organs and systems Ongoing assessment i.e. monitoring.

In general, poisoning should be considered in:

Any previously well patient Presents with acute change in mental status or Brain functions as lethargy, agitation, delirium, seizures, apnea or coma.

The presence of focal neurological signs usually rules out the possibility of poisoning. Non-toxigenic differential diagnosis should be considered as:

1. Head trauma2. Meningitis3. Encephalitis 4. Cerebrovascular accidents5. Psychological disorders6. Post-ictal state.

 

There are 3 basic questions to be asked:

1. WHAT?2. HOW MUCH? 3. WHEN?

 Other important questions should be considered as regards:

• If the patient visited or was visited by someone.• Open bottles. • Special odors.• Medications given at home.• Inquiring about symptoms and signs.

MANAGEMENTInitial therapy:

• Maintaining patent airway and establishing effective breathing.• Full assessment: Clinical, laboratory, etc.• Removal of the poison, or diminishing its absorption.

Additional therapy:

1. Providing continuous supportive care (if needed).2. Giving specific antidote (if any).3. Actively removing the toxin from blood stream.

The Therapeutic Interventions Will Depend Primarily Upon The State of Consciousness:I. Management of the conscious child: After a fulI clinical examination, including serial measurements of

Vital Signs, and repeated evaluation of organs and systems functions.

You can safely send the patient to home if he remains asymptomatic after 4-5 hours of observation, provided that he can easily return to hospital if necessary.

II. Management of the unconscious child: Life support measures and monitoring in PICU:

1. Airway2. Breathing3. Circulation4. I.V line5. Urinary catheterization6. NG tube

The General rule here is TO GIVE NALOXONE rapid IV If the is no or a suspected history of a poison intake. If the poison is one of the opiate derivatives, then rapid recovery will. If not, no harm from naloxone intake

Methods To Diminish Absorbtion of PoisonsTarek Amoun

Methods To Diminish Absorption of poisons

1-Ipecac syrup

-10-15 mlfollowed by

water

2-Gastric lavage

- saline in infants

- water in older children

3-Activated charcoal

- Capable of adsorbing

nearly all drugs- Every 2 hrs

until the charcoal

appears in stools.

4-Cathartics

- magnesium citrate & sorbitol

- only in older children

5-Methods of enhancing

poison excretion

- Forced diuresis- Hemodialysis

- Hemoperfusion

(little value)

<4 hrs.

Antidotes of common poisons

Poison Antidote Anticholinergics Physostigmine Arsenic & mercury Dimercaptol, D-penicillinase Benzodiazepines Flumazenil Beta blockers Glucagon Botulism Botulism antitoxin Calcium channel blockers Calcium, Glucagon Chlorine gas Sodium Bicarbonate Cyanide Amyl or sodium nitrate, Thiosulfate Digitalis Digoxin-specific FAB

AntidotesPoison AntidoteHeparin ProtamineHypoglycemic agents & insulin DextroseIron DesferroxamineLead Calcium EDTA, Dimercaprol, DMSAMethanol Ethanol, Folate, lucovorin, fomeprizolMet-Hb forming agents Methylene blueMethotrexate Folate, LeucoverinOpiates Naloxone, NalmefeneOrganophosphorous Compounds Atropine, PralidoxineParacetamol N-acetylcystienTricyclic Antidepressants Sodium BicarbonateWarfarin Anticoagulants Vit. K

Prevention of Poisoning

Prevention of Poisoning

Most toxic ingestions occur at home

Education of parents:

keep dangerous

materials out of reach of children in

locked cabinets.

Toxic substances should not be stored in ordinary bottles, jugs, cans and cups, which are normally used for drinkin

Old, unused medications should be discarded

Do not leave medication on tabletops or in mother’s purse. Better keep it in “childproof” or “child-resistant” medication containers.

Thank You