1. بسم الله الرحمن الرحيم Principles of Management of Poisoned Patient
د/ عبد المنعم جودة مدبولى
دكتوراة الطب الشرعي و السموم الإكلينيكية,
مدرس الطب الشرعي و السموم الإكلينيكية,
استشاري علاج التسمم بمستشفى بنها الجامعي
30/07/1438
Dr Abdelmonem G. Madboly

2. = treat patient, not poison
Objectives (ILOs):
General management of poisoned patient:
Patient with normal mental status or alert patient (Stable).
Patient with altered mental status or coma (Unstable).
= treat patient, not poison

3. Dr Abdelmonem G. Madboly
Role of Doctor
Management:
1- Diagnosis
2- Treatment
Medico-Legal Aspect
1- Manner
2- Samples
3- Authority inform
4- Tox. Report
26 April 2017
Dr Abdelmonem G. Madboly

4. Dr Abdelmonem G. Madboly
Treatment
Unstable
1- Emergency
stabilization ABCDEs.
2- Initial therapy
(Empiric antidote)
3. Emergent therapy.
+ تكمل من رقم 1 فى alert
Stable
Proper clinical
evaluation.
2. Decontamination &
Enhanced Elimination.
3. Antidote.
4. Sympt. (Supportive) ttt.
5. Discharge & follow up.
6- Prevention re-exposure
= Treat the patient, not the poison
26 April 2017
Dr Abdelmonem G. Madboly

5. B = Breathing: How to know: Clinical exam. (Resp. rate, Cyanosis………..)
Perform arterial blood gas )ABG) analysis to monitor:
The adequacy of oxygenation by measuring PO2 (normal : mmHg or Kpa “kilopascal”) and O2 saturation (normal: % or KPa)
The adequacy of alveolar ventilation by measuring PCO2 (normal values are mmHg).
Pulse oximetry : مهمممم
Not reliable in patients with methemoglobinemia or carbon monoxide poisoning.

6. Methods of O2 administration:
Mouth to mouth.
AMBU bag (Bag valve mask).
Nasal cannula.
Nasal musk.
Mechanical ventilation (ventilator).
+ ttt of Cause: (respiratory arrest, bronchospasm, pulmonary aspiration, or noncardiogenic pulmonary edema).

7. C = Circulation: Cause of abnormal circulation: How to know:
Hypotension & shock…………….
Dysrhythmias………………………
Bleeding & hemorrhage…………
How to know:
Measure pulse and blood pressure
Estimate tissue perfusion (urinary output, skin signs, pH).
Insert an intravenous line, and draw blood samples.
How to treat (hypotension)

8. ttt of Hypotension & shock:
Position & Warming of patient .
IV fluids (up to 2 L in adults or to a systolic blood pressure of 100 mmHg).
Vasopressors (dopamine or dobutrex ).
Continuous ECG monitoring: antiarrhythmic agents such as lidocaine or phenytoin
Cardiopulmonary resuscitation (CPR) for cardiac arrest.
ttt of cause (antidote).
ttt of ppt factors “arrhythmogenic factors”:
(hypoxia, met. acidosis, dysrhythmias & hypokalemia)

9. Depression (D) or Excitation (E):
ttt of Coma (Coma cocktail): DONT
ttt of depression (Coma cocktail):
= dextrose, oxygen, thiamine & naloxone
Excitation = seizures:
Diazepam
Phenobarbital
Phenytoin
General anaesthesia
Drug elimination by haemodialysis.
Treatment of violent patient (Agitati
= Benzodiazepines & haloperidol.
ttt of seizures (Convulsions):
ttt of violent patient (Agitation)

10. II- Initial Therapy (Empiric Antidote )
DONT
(Coma cocktail)

11. Def.: drugs which should be used as diagnostic or therapeutic agents for the comatose patient.
Drugs: DON’T
Dextrose (Hypertonic) 0.5 to 1 g/kg of 50% dextrose in water (D50W) for an adult, or D10W or D25W for a child.
Oxygen 100%
Naloxone (Narcan), 2 mg (5 ampoules, each 0.4 mg) intravenous for adults and children.
Thiamine, 100 mg intravenous for an adult (usually unnecessary for a child).

12. Emergent therapy: Some urgent manifestations: Some specific antidotes.
Coma …………………………….
Convulsions ……………………
Pulmonary edema …………..
Cerebral edema ……………..
Metabolic Acidosis ………….
Some specific antidotes.