POISONING AND SNAKE BITE Rx GUIDE

 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 Rx

Organophosphate 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):

1. Airway:
   • Ensure airway patency and stability.
2. Breathing:
   • Check SpO2, administer high-flow O2.
3. 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.
4. Disability & Exposure:
   • Remove from exposure, decontaminate skin/clothing.
   • Consider early ICU/HDU admission.
   • Monitor GCS, pupillary reflexes.
   • Correct underlying cause.

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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):

1. Airway:
   • Ensure airway patency and stability.
2. Breathing:
   • Check SpO2, administer high-flow O2.
3. 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.
4. Disability & Exposure:
   • Monitor for CNS depression.
   • Consider ICU/HDU admission.
   • Observe for 12-24 hours.
   • Radiology: CXR, CT brain.

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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):

1. Airway:
   • Ensure airway patency.
2. Breathing:
   • Check SpO2, administer high-flow O2.
3. 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).
4. Disability & Exposure:
   • Monitor for seizures, administer Diazepam if required.
   • Observe for 6-8 hours, refer for psychiatric evaluation if stable.
   • Radiology: CT, CXR.

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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):

1. Airway:
   • Ensure airway patency and stability.
2. Breathing:
   • Check SpO2, administer high-flow O2.
   • Give Syp Aluminum Hydroxide (Mucain/Gaviscon) stat.
   • Syp Sucralfate 2 tsp TDS.
3. 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.
4. Disability & Exposure:
   • Remove contaminated clothing.
   • Monitor pupillary reflexes, GCS.
   • Avoid gastric lavage.
   • Radiology: CXR, OGD.

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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):

1. Airway:
   • Ensure airway patency and stability.
2. Breathing:
   • Check SpO2, administer high-flow O2.
3. Circulation:
   • IV access, fluids as needed.
   • Administer Ceftriaxone if infection is suspected.
   • IV fluid: Ringer Lactate 1L stat.
   • Manage seizures: Diazepam or Levetiracetam.
4. Disability & Exposure:
   • Monitor for signs of aspiration, avoid gastric lavage.
   • Radiology: CXR for pneumonitis.

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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):

1. Airway:
   • Ensure airway patency, intubation/tracheostomy if necessary.
2. Breathing:
   • Check SpO2, administer high-flow O2.
3. Circulation:
   • IV access, fluids, diuretics for forced diuresis.
   • Administer Mannitol if oliguric.
   • Omeprazole, Ceftriaxone for infection.
   • Cardiac support: Dopamine for hypotension.
4. Disability & Exposure:
   • Monitor GCS, urine output, correct underlying cause.
   • Consider ICU/HDU admission.
   • Radiology: Chest X-ray, ECG.

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Snake Bite Treatment (Rx)

C/C (Clinical Complaints):

• Local pain, swelling, discoloration.
• Coagulopathy, bleeding, neuromuscular blockade, shock.

Rx (Treatment):

1. Airway:
   • Ensure airway patency.
2. Breathing:
   • Check SpO2, administer high-flow O2.
3. 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.
4. **Disability & Exposure

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• Observe for signs of systemic envenomation (coagulopathy, neurotoxic effects).
• Radiology: CXR, CT if indicated.