Poisoned patientgeneral evaluation:

General approach to poisoned patient.

First :Resuscitation and triage.Second: comprehensive evaluation(clinical assessment)

first: triage and resuscitation

•1-immediate measurement of vital signs•2-assess conscious level.

•2-identify poison involved and obtain adequate information about it.(obtain history) 3-decontamination for those with possible external contamination.

•4 -identifying patients at risk of further attempts at self harm.

•5-critically ill patient should be resuscitated.

•6-E.C.G should be performed and cardiac monitoring instituted in all patients with cardiovascular features or possible cardio toxic substances.

•7-weight of patient when feasible •8 -substances of very low toxicity

should be identified so inappropriate admission and intervention are

avoided .

Taking history in poisoned patient

•1-what toxin(s) have been taken and how much.•2-what time were they taken and by what route•3-has alcohol or any drug of misuse been taken

as well.•4-details of circumstances of overdose from

family, friends and ambulance friends.•5-ask the general practitioner for background

and details of prescribed medication.•6 -assess suicide risk by full psychiatric

evaluation.

SECOND:comprehensive evaluation of poisoned patient:what do examine:(clinical assessment).

•1-ABC vital signs, oxygen satutation.•2-level of consciousness.

•3-chest.•4-movement of muscles.

•5-reflexes .•6-eyes.

•7-psychiatric evaluation•8-mouth .

•9 -skin.•10 abdomen.

Clinical signs suggestive of poisoning•1-small pupil:opioids,organophosphorus

compounds, clonidine.•2 -dilated pupils: tricyclic

antidepressants,cocaine,amphetamine.•3-hypotension:tricyclic antidepressant and

haloperidol.•4-cocaine causes hypertension.

•5-decreased respiratory rate:opioids,benzodiazepine.

•6-increased respiratory rate: salicylate.

•7-right upper quadrant:paracetamol hepatotoxicity.

•8-renal angle tenderness: salicylate poisoning.•9-epigastric tenderness:NSAIDS.•10 -rhabdomyolysis:amphetamine.

•11-hperthermia:salicylates.•12-hypothermia:any CNS DEPRESSANTS DRUGS.

•13-TACHCARDIA:TCA,theophylline,digoxine .•14-bradycardia:b-blocker,calcium channel blocker

15-needle tracks: opioids and drugs of misuse.16-extrapyramidal signs:phenothiazine;haloperidol

Investigations:

•1-Urea,creatinine,electrolytes should be measured in most patients.

•2-ABG in most patient who are respiratory and cardiac compromised.

•3-toxin screen in blood.•4-urine for toxicology screen.

General management:

•1 -patients with skin and eyes contamination should be

decontaminated locally.•2 -patient who have ingested potentially

life threatening quantities of toxins may be considered for gastrointestinal

decontamination. If poisoning has been recent .