Accidents and Poisonings Edited

ACCIDENTS ANG POISONING
DROWNING
Definitions
Drowning – used when the victim dies
Near drowning – used when submersion victim survives
The places where drowning occurs:

 Small infants may drown in – bathtubs, home pool and ponds
 Older children - Drowning may occur in swimming pools, lakes or river
Common clinical features

Patient with near drowning can be grouped into three categories
1. Category A – Patients are awake and conscious
2. Category B - Victims are in stupor, have respiratory distress and cyanosis and hypothermia
3. Category C – Patients are comatose, have central cyanosis and may be in a decorticate,
decerebrate or flaccid state
Treatment
 Immediate resuscitation for basic life support
Category A and B require supportive care
Category C requires advanced life support care
 Diuretics – for pulmonary oedema (IV Frusemide 1-2 mg/kg)
 Sodium bicarbonate – for metabolic acidosis ( IV NaHCO3 1-2 ml/kg)
 Convulsions – Diazepam 0.3-0.5 mg/kg per rectum or a loading dose of Phenobarbitone 15
mg/kg IM can be used
 Hypothermia – Adequate warming
POISONING
General management
1. Emergency stabilization measures
 The unconscious patient should be transported in a head down semi-prone position
 To establish clear air way and maintain ventilation
 Urgent correction of potentially serious abnormalities such as metabolic acidosis,
hyperkalaemia and hypoglycaemia
 Neurological assessment is made by Glasgow Coma Scale (GCS)
 Convulsions - Control with diazepam
 Correction of hypotension and peripheral circulatory failure
 Regulation of body temperature
2. Identification of poison
 History, supportive evidence and laboratory analysis
3. Removal of poison
 Eye decontamination – by copious irrigation with neutralizing solution (e.g. water or normal
saline) at least 30 minutes
 Dermal decontamination – removal all decontaminated clothes and irrigate the whole body
with water and saline as soon as possible after exposure
 Gut contamination – Emesis and gastric lavage
4. Administration of antidotes
The appropriate antidotes for 6 common poisoning
1. Milk and egg albumin for acid and corrosive poisoning
2. Vinegar and water for alkali poisoning
3. Naloxone for opiate poisoning
4. Ca EDTA and penicillamine for lead poisoning
5. Desferrioxamine for iron poisoning
6. Atropine and pralidoxime for insecticide poisoning
Poisons Antidotes
 methanol Ethanol
 Mushroom Atropine
 Iodine Sodium thiosulphate
 Atropine Physostigmine
 Digoxin Antidigoxin Fab
5. Promotion of excretion of toxin
 Forced alkaline diuresis - with 1.4% sodium bicarbonate
 Forced acid diuresis – with ammonium chloride 4 gm, give every 2 hours through Ryle tube
 Haemodialysis – method of choice for removal of methanol and lithium
Haemoperfusion – with coated charcoal or exchange resin
 Peritoneal dialysis – less effective, advantages – no special facilities required
6. Other supportive therapy
 Anaemia – Packed cell transfusion
 Infection – Antibiotics
Brief diagnostic clinical features and management of common childhood
poisoning
Bacterial food poisoning

Diagnostic clinical features
 When two or more persons who have ingested a common food develop similar signs of acute
illness characterized by nausea, emesis, diarrhea or neurologic symptoms
Management
Mostly supportive therapy –
 Adequate rehydration by parental fluid
 Antibiotics
- Chloramphenicol for salmonella food poisoning
- No antibiotics for staphylococcal food poisoning
 Preventive measures
- Proper refrigeration of food
- Proper hygienic technique in food preparation
Kerosene poisoning
 History of accidental ingestion, history of coughing, chocking or vomiting
 Characteristic smell gives the clue
 Respiratory difficulties, cyanosis, tachycardia and fever
 Features of pneumonia, pulmonary oedema and haemorrhage with cardiac arrythemias
 Hepatopmegaly, proteinuria, haematuria occurs following large overdose
Management
 Mainly symptomatic and supportive
 Induction of emesis or gastric lavage is contraindicated
 Oxygen and physiotherapy and if necessary, positive airway pressure and other ventilatory
assistance
 Observation for at least 24 hours, even in asymptomatic child
Lead poisoning
 History of inhalation of lead fumes, history of ingestion of lead paint chips or repetitive ingestion
of inorganic lead compound, from battery shops and domestic use, history of pica
 May be asymptomatic and detected only on screening
 Older children may manifest as pain in abdomen and resistant anaemia
 Younger children manifest as acute lead encephalopathy
Investigations
 Blood CP – Microcytic hypochromic anaemia with punctuate basophilia
 Lead lines at growing ends of long bones in radiological examination
 Blood lead level – increased (between 50-99 μg/100ml in asymptomatic patients and >100
μg/100ml in patient with definite lead poisoning)
 Urinary corprophyrin level – Increased (Normal – 100-200 μg/day)
Management
 Remove from exposure
 Specific Antidote – Calcium EDTA
 D- penicillimine
 Treatment of cerebral oedema
 Anticonvulsants for seizures
 Fluid and electrolytes replacement
 Follow up regularly at least until school age to prevent recurrence and to assess the degree of
recidual brain damage
Insecticide (Organophosphate) poisoning

 Excessive parasympathetic activities, weakness, blurred vision, headache, giddiness, nausea
and chest pain
 Excessive secretions in the lungs, profuse sweating and marked salivation
 Constricted pupil, papiloedema, muscle twitching convulsion and coma in severe cases
 Reflexes are absent and sphincter control is lost
Management
 If there has been contact with insecticide, skin or eyes, these are thoroughly washed with normal
saline
 Gastric lavage
 IV Atropine sulphate 0.05 mg/kg. May need to repeat dose if unresponsive
 IV Pralidoixime 25 mg/kg given over 30 minutes every 8-12 hours in young children. In older
children, maximum dose (1G/dose) may be given
 Artificial respiration may be necessary to sustain life
Tapioca poisoning
 History of eating tapioca (Pa-Law-Pe-Nan)
 Poisoning is due to cyanide that is contained in the root
 Blue lips (Cyanosis), shock, respiratory difficulties and nausea or vomiting
Management
 Severe case should be hospitalized
 Keep airway clear
 Give oxygen if cyanosis is present
 Gastric lavage
 Treat shock by intravenous fluid
 Antidote – IV Sodium nitrite, 10 ml of 3% solution (300 mg) followed by Sodium Thiosulphate,
50 ml of 25% solution
Paracetamol poisoning
 History of ingestion or high index of suspicion
 Anorexia, nausea, vomiting, malaise, pallor, right upper quadrant abdominal pain and tenderness
 Peak liver function abnormality, resolution of hepatic dysfunction or complete liver failure
Investigations
 Measure plasma level of hepatic enzymes and bilirubin
 Prothrombin time should be measured daily in patient with toxic level
 Renal function should be monitored
Management
 Used of activated charcoal - if present within 2 hours of ingestion
 Antidote – N-acetylcysteine to be given if the blood level is above the toxic range compared with
normograph
Prevention of accidental poisoning

1. Protection of the child
2. Clear labeling
3. Keep household chemicals and poisons out of sight and reach of children
4. Dangerous drugs should be stored in bottles with safety cap
5. Education of parents about the hazard of household and drugs laws

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ACCIDENTS ANG POISONING

The places where drowning occurs:

Common clinical features

Bacterial food poisoning

Insecticide (Organophosphate) poisoning

Prevention of accidental poisoning

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