复旦大学：《内科学 Internal Medicine MBBS》课程教学资源（课件讲稿）重症监护医学_poisoning and drug overdosage

POISONING AND DRUG OVERDOSAGE Department of Internal Medicine WAN Weiguo

POISONING AND DRUG OVERDOSAGE Department of Internal Medicine WAN Weiguo

General Info All chemicals have potential to be poisons if given a large enoug h dose Poisoning occurs when exposure to a substance adversely affects function of any organ system a3 factors toxicants i dose-related hazards to the body

General Info  All chemicals have potential to be poisons if given a large enough dose  Poisoning occurs when exposure to a substance adversely affects function of any organ system  3 factors toxicants ; dose-related ; hazards to the body

Definition Development of dose-related adverse effects Following exposure to chemicals, drugs, or other xenobiotics

Definition: Development of dose-related adverse effects following exposure to chemicals,drugs,or other xenobiotics

classification Chemicals fron: industrial、 medicine、 pesticide、 plants、 animals ● Organ or tissue involved: cardiovascular、 respiratory, nerve, liver, kidney blood Causation: occupational, daily life Onset: acute, subacute, chronic

classification  Chemicals from：industrial、medicine、 pesticide、 plants、 animals  Organ or tissue involved：cardiovascular、 respiratory, nerve, liver, kidney, blood  Causation：occupational, daily life  Onset：acute, subacute, chronic

Epidemiology More than 5 million toxic exposures reported in 2006 US each year Over half were children 6 yo Poisoning third leading cause of death from 1985-1995 Most are acute and accidental 5% require hospitalization Incidence of toxin related deaths increase 300%, Mortality 0.4%

Epidemiology  More than 5 million toxic exposures reported in 2006 US each year  Over half were children < 6 yo  Poisoning third leading cause of death from 1985-1995  Most are acute and accidental  5% require hospitalization  Incidence of toxin related deaths increase 300%, Mortality 0.4%

Resuscitation First priorities are abcs(air, breath, circulation) Vital sign including pulse oximetry and hypoglycemia must be corrected a Only in very rare incidences does administration of antidote precede stabilizing ABCs and vital signs pulse oximetry blood gas analysis)

Resuscitation  First priorities are ABC’s(air,breath,circulation)  Vital sign including pulse oximetry and hypoglycemia must be corrected  Only in very rare incidences does administration of antidote precede stabilizing ABC’s and vital signs  pulse oximetry(blood gas analysis)

Resuscitation Unresponsive pt' s treated empirically with coma cocktail Oxygen, naloxone, D50W, and 100mg thiamine 50 ml of d50W for adults and 1g/kg glucose for children(4ml/kg D25W or 10ml/kg of D10W) Thiamine not usually given to children a Glucose and thiamine should be given in timely manner however thiamine does not have to precede glucose to prevent Wernicke's (D50W=50% dextrose

Resuscitation  Unresponsive pt’s treated empirically with coma cocktail  Oxygen, naloxone, D50W, and 100mg thiamine  50 ml of D50W for adults and 1g/kg glucose for children (4ml/kg D25W or 10ml/kg of D10W)  Thiamine not usually given to children  Glucose and thiamine should be given in timely manner however thiamine does not have to precede glucose to prevent Wernicke’s (D50W=50% dextrose)

History Need to obtain as much info as possible about exposure Number of exposed persons, type of exposure amount or dose, route Pt's intent must be determined Info from pt's primary care physician witness or emt(mergency medical technican) helpful Check for empty bottles or containers, smells or unusual containers or suicide not

History  Need to obtain as much info as possible about exposure  Number of exposed persons, type of exposure, amount or dose, route  Pt’s intent must be determined  Info from pt’s primary care physician, witness or EMT(mergency medical technican) helpful  Check for empty bottles or containers, smells or unusual containers, or suicide not

Physical Exam Undress pt completely for thorough exam Check clothing for objects or substances Assess general appearance of pt Agitation confusion, or obtundation Exam skin for bruising, cyanosis, flushing EXam eyes for pupIls SIze, nystagmus, reactivity dysconjugate gaze, increased acramation

Physical Exam  Undress pt completely for thorough exam  Check clothing for objects or substances  Assess general appearance of pt  Agitation, confusion, or obtundation  Exam skin for bruising, cyanosis, flushing  Exam eyes for pupils size, nystagmus, reactivity, dysconjugate gaze, increased lacramation

Physical Exam Oropharynx for increase salivation or excessive dryness Cardiovascular: rhythm, rate, regularity Lungs: bronchorrhea or wheezing Abd: bowel sounds, tenderness or rigidity Exterior fasiculations tremor Neuro: CN, reflexes, muscle tone coordination cognition ability to ambulate

Physical Exam  Oropharynx for increase salivation or excessive dryness  Cardiovascular: rhythm, rate, regularity  Lungs: bronchorrhea or wheezing  Abd: bowel sounds, tenderness or rigidity  Exterior: fasiculations, tremor  Neuro: CN, reflexes, muscle tone coordination, cognition, ability to ambulate