POISONING AND SNAKE BITE Rx GUIDE
TABLE OF CONTENTS
ORGANOPHOSPHATE POISONING Rx
BENZODIAZEPINES POISONING Rx
OPIOIDS POISONINGS Rx
ACIDS/CAUSTIC INGESTION Rx
KEROSENE POISONING Rx
PARAPHENYLENEDIAMINE (PPP) POISONING Rx
SNAKE BITES ER/WARD RxOrganophosphate Poisoning Treatment (Rx)
C/C (Clinical Complaints):
- DUMBBELLS-F are positive:
- Diarrhea
- Urination
- Miosis (Pinpoint pupils)
- Bradycardia
- Bronchospasm
- Bronchorrhea
- Emesis (Vomiting)
- Lacrimation
- Lethargy
- Salivation
- Sweating
- Fasciculation
Pathophysiology of OP Poisoning:
- Absorbed through skin, respiratory system, or GI tract.
- Irreversible acetylcholinesterase inhibition → increased acetylcholine levels → activation of muscarinic and nicotinic receptors.
- Life-threatening parasympathetic activation.
- Cholinergic excess → cholinergic syndrome: muscarinic (DUMBBELLS), nicotinic (flaccid paralysis, respiratory arrest), CNS (seizures, coma).
- The greatest danger is respiratory failure.
Rx (Treatment):
- Airway:
- Ensure airway patency and stability.
- Breathing:
- Check SpO2, administer high-flow O2.
- Circulation:
- Establish IV access.
- Administer 0.9% Normal Saline (N/S) IV stat.
- Monitor vital signs: BP, HR, RR, temperature, SpO2.
- Send labs: CBC, U/C/E, LFTs, RBS, PT INR, ABGs, acetylcholinesterase level.
- Administer Inj R/L 1L IV BD, Inj Omeprazole 40 mg IV OD, Inj Ceftriaxone 1g IV BD.
- Inj Atropine 2-4mg IV stat, increase dose every 10 minutes as needed until atropinization. Alternative: Pralidoxime.
- Follow local protocol for atropine and pralidoxime doses.
- Disability & Exposure:
- Remove from exposure, decontaminate skin/clothing.
- Consider early ICU/HDU admission.
- Monitor GCS, pupillary reflexes.
- Correct underlying cause.
Benzodiazepine Poisoning Treatment (Rx)
C/C (Clinical Complaints):
- CNS depression: lethargy, somnolence.
- Respiratory depression.
- Mild hypotension.
- Hypotonia, ataxia, slurred speech.
Differential Diagnosis:
- Other sedative-hypnotics (e.g., alcohol, barbiturates, phenytoin).
- Nystagmus is absent in benzodiazepine overdose (present in alcohol, phenytoin overdose).
Rx (Treatment):
- Airway:
- Ensure airway patency and stability.
- Breathing:
- Check SpO2, administer high-flow O2.
- Circulation:
- Establish IV access.
- Administer 0.9% Normal Saline (N/S) IV stat.
- Monitor vital signs: BP, HR, RR, temperature, SpO2.
- Send labs: CBC, U/C/E, LFTs, RBS, PT INR, ABGs, urine toxicology.
- Administer crystalloid fluids: Inj R/L and N/S 1L IV BD/TDS.
- Inj Omeprazole 40 mg IV OD, Inj Ceftriaxone 1g IV BD, Inj Haemaccel for shock.
- Flumazenil: 0.3 mg IV, repeat as necessary up to 2 mg, use with caution due to seizure risk.
- Disability & Exposure:
- Monitor for CNS depression.
- Consider ICU/HDU admission.
- Observe for 12-24 hours.
- Radiology: CXR, CT brain.
Opioid Poisoning Treatment (Rx)
C/C (Clinical Complaints):
- Altered mental status, miosis (pinpoint pupils).
- Respiratory depression, decreased respiratory rate and tidal volume.
- Seizures, decreased bowel sounds, hypothermia.
Rx (Treatment):
- Airway:
- Ensure airway patency.
- Breathing:
- Check SpO2, administer high-flow O2.
- Circulation:
- Establish IV access, monitor vital signs.
- Send labs: CBC, U/C/E, LFTs, blood glucose, ABGs, toxicology.
- Administer Naloxone 0.4-2 mg IV stat, titrate to response.
- IV fluid resuscitation: N/S or R/L 1L stat.
- Repeat Naloxone if needed (due to shorter half-life).
- Disability & Exposure:
- Monitor for seizures, administer Diazepam if required.
- Observe for 6-8 hours, refer for psychiatric evaluation if stable.
- Radiology: CT, CXR.
Caustic/Acid Ingestion Treatment (Rx)
Examples of Caustics/Acids:
- Sulfuric acid, nitric acid, hydrochloric acid, acetic acid, phenol, boric acid, hydrofluoric acid, oxalic acid.
- Alkalis: Ammonia, bleach, sodium hydroxide.
Rx (Treatment):
- Airway:
- Ensure airway patency and stability.
- Breathing:
- Check SpO2, administer high-flow O2.
- Give Syp Aluminum Hydroxide (Mucain/Gaviscon) stat.
- Syp Sucralfate 2 tsp TDS.
- Circulation:
- Establish IV access, start N/S 0.9% IV stat.
- Monitor vital signs.
- Send labs: CBC, U/C/E, LFTs, blood glucose, ABGs.
- Administer IV fluids, Ceftriaxone 1g IV BD, Omeprazole 40 mg IV OD.
- Manage pain: Inj Ketorolac 30 mg IV.
- If vomiting: Dimenhydrinate 50 mg IV.
- Disability & Exposure:
- Remove contaminated clothing.
- Monitor pupillary reflexes, GCS.
- Avoid gastric lavage.
- Radiology: CXR, OGD.
Kerosene Poisoning Treatment (Rx)
C/C (Clinical Complaints):
- Asymptomatic or progressing to respiratory failure.
- Symptoms: cough, choking, wheezing, dyspnea, cyanosis.
- CNS: Headache, dizziness, seizures.
- GIT: Vomiting, hematemesis, abdominal pain.
- Skin: Chemical burns.
Rx (Treatment):
- Airway:
- Ensure airway patency and stability.
- Breathing:
- Check SpO2, administer high-flow O2.
- Circulation:
- IV access, fluids as needed.
- Administer Ceftriaxone if infection is suspected.
- IV fluid: Ringer Lactate 1L stat.
- Manage seizures: Diazepam or Levetiracetam.
- Disability & Exposure:
- Monitor for signs of aspiration, avoid gastric lavage.
- Radiology: CXR for pneumonitis.
Paraphenylenediamine (PPD) Poisoning Treatment (Rx)
C/C (Clinical Complaints):
- Throat pain, difficulty breathing, stridor, tongue swelling.
- Muscle rigidity, rhabdomyolysis, dark urine.
- Hyperkalemia, acute renal failure, shock.
Rx (Treatment):
- Airway:
- Ensure airway patency, intubation/tracheostomy if necessary.
- Breathing:
- Check SpO2, administer high-flow O2.
- Circulation:
- IV access, fluids, diuretics for forced diuresis.
- Administer Mannitol if oliguric.
- Omeprazole, Ceftriaxone for infection.
- Cardiac support: Dopamine for hypotension.
- Disability & Exposure:
- Monitor GCS, urine output, correct underlying cause.
- Consider ICU/HDU admission.
- Radiology: Chest X-ray, ECG.
Snake Bite Treatment (Rx)
C/C (Clinical Complaints):
- Local pain, swelling, discoloration.
- Coagulopathy, bleeding, neuromuscular blockade, shock.
Rx (Treatment):
- Airway:
- Ensure airway patency.
- Breathing:
- Check SpO2, administer high-flow O2.
- Circulation:
- IV access, fluids, hydrocortisone, pheniramine.
- Polyvalent anti-snake venom (ASV).
- Monitor vitals, send labs (CBC, PT/INR).
- Correct electrolyte imbalances, use FFPs if necessary.
- **Disability & Exposure
:**
- Observe for signs of systemic envenomation (coagulopathy, neurotoxic effects).
- Radiology: CXR, CT if indicated.
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