POISONING AND SNAKE BITE Rx GUIDE

 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.

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.

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.

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.

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.

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.

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

:**

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

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