Acute poisoning Z. Rozkydal •Acute poisoning • •It is an intoxication by venoms •A poison can cause permanent or temporary damage • •Man- made poisons •Natural poisons • • 1. inhaled 2. swallowed 3. absorbed through the skin 4. injected through the skin s.c., i.m., i.v. •5. splashed into the eye • •Signs • •Vary with the type of poison •They develop quickly or over a couple of days • •Diminished breathing • •Arrythmia, hypotension • •Diminished GI activity • •Rhabdomyolysis, renal failure • •Impaired liver function • •Oedema of the brain, seizers, unconsciousness • •First aid • •Stop action of the poison • •Monitor vital signs • •Ensure the poison for further examination • •Transport to hospital •Consequenses • •Hypoxia • •Edema of the brain • •Renal failure • •Liver failure •Swallowed poisons • •Chemicals, drugs, corrosive substances • •Signs •History of ingestion •Nausea, vomiting, abdominal pain •Burning sensation in the face and extremities •Seizures •Impaired consciousness • •First aid •To maintain open airways, breathing, circulation •To identify the poison •In a case of corrosive substances- cold milk or water •Urgent removal to hospital • •Medicines •- benzodiazepins, barbiturates • •Signs •Fatique, difficult speech, diminished breathing •Dizziness, nausea and vomiting, hypotension •Hypothermia, impaired consciousness • •First aid, management • •Induce vomiting (fingers into the throat, salty water, ipeca) • hypertonic solution of saline) •Irrigation of the stomach •Enema •Medicines •- paracetamol • •Signs •Nausea, vomiting, abdominal pain •Pale, sweating, redness of the skin •Hypotension •Haemolytic anemia, liver failure • •First aid, management •Induce vomiting (fingers into the throat, salty water, ipeca) • hypertonic solution of saline) •Irrigation of the stomach •Drips with saline •N- acetylcystein •Botulism • •Toxins from Clostridium botulinum A, B, E • in tinned meat or contaminated meal •Signs •After 18-36 hours weakness, head nerve palsy •Feeling of dry mouth, disturbance of vision •Nausea and vomiting, convulsion, diarrhoea •Bulbar paralysis (dysarthria, dysphagia, diaphragma palsy) • •First aid •Induce vomiting, irrigation of stomach, CPR • •Management •Ventilation, antitoxin •Mushroom poisoning • •Amanita phaloides •- amanitins: peptids causing liver failure •- phaloidins: peptids causing nausea, vomiting and diarrhoea - •Signs •After 6–12 hours sweating, watering from the eyes •Salivation, miosis •Abdominal pain, vomiting, convulsions, haemorhagic diarhoea •Dizziness, oliguria, jaundice, coma • •Mortality: 50 % • •First aid •Induce vomiting, irrigation of stomach, CPR Inhalation of fumes Carbon monooxiden - motor vehicles, chimney fumes, emissions from defective heaters Carbon dioxide -underground tanks, wells Smoke -fire smoke, may contain toxic fumes - Solvents and fuels - cleaning fluids, glues, camping gas - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Zdroj: výfukové plyny, vytápění se spalováním svítiplynu nedokonalé spalování zemního plynu CO má vyšší afinitu k hemoglobinu než kyslík (COHb) Vysoké množství karbonylhemoglobinu ( COHb) v séru Inhibice buněčného dýchání - tkáňová hypoxie Symptomy: bolest hlavy, nauzea, zvracení, únava poruchy vidění, parestezie, závratě, zmatenost, dezorientace bolesti na hrudi a břicha, průjem, cyanóza a bledost kůže tachykardie a tachypnoe, křeče, kolaps útlum dýchání a edém plic, kóma První pomoc: čerstvý vzduch, dýchání z úst do úst Léčba: intubace, řízené dýchání, aplikovat 100% kyslík •Inhalation of fumes • •Signs • •Headache, confusion •Nausea and vomiting, diarrhoea •Caughing, difficult breathing •Chest pain, cyanosis, pale or grey glue skin •Tachycardia, flat and fast breathing, seizures •Oedema of lungs •Dizziness, desorientation •Impaired consciousness •Unconsciousness •Carbon monooxide has higher affinity to haemoglobin •than oxygen • •It produces carbonylhaemoglobin CoHb • •This leads to tissue hypoxia First aid Be careful to enter the place with fumes -open the door, open the window - Be careful not to breathe the fumes yourself Remove the casualty from the place into fresh air Encourage the casualty to breathe normally Monitor vital signs CPR •Animal bites • •Sharp pointed teeth •Damage of tissues, crush of tissues •Bacterial infection •Infection of rabies •Infection of tetanus • •First aid • •Wash the wound thoroughly with warm water and soap •Sterile dressing •Send to hospital •Tetanus immunisation, antirabies injections •Surgical management • •Insect sting • •A sting from bee, wasp • •Signs •Pain at the site of the sting •Redness and swelling •In the mouth it can obstruct the airways • •First aid •In the mounth- ice cube to suck, cold water to sip •To brush or scrape it off sideways •Not to use tweezers •To raise the affected part •Cold compresses •Risk of anaphylactic shock- adrenalin •Medical advice • •Tick bite • •Ticks, scorpions, other spiders • •Ticks suck the blood, carry diseases • •First aid •Use a tweezer •Grasp as much as to the skin •Gently pull out and rotate •Remove completely • •Do not use an oil or butter •Allergic reaction •Obstruction of airways •Medical advice •Snake bite • •Viper, adder, cobra •In 20 % they are venomous • •Signs •A pair of puncture marks •Sever pain, redness and swelling •Nausea and vomiting •Disturbed vision, colour vision •Metal taste, anestesia around the mouth •Sweating, weakness •Bleeding from jaws, convulsions •Haematuria, renal failure, disturbed breathing •Shock •First aid • •To prevent venom spreading •Urgent removal to hospital • •In a case quick transport: •pressure bandage- extended up the limb •immobilisation, elevation, sterile dressing •Do not use tourniquet • •In a case of a long journey to hospital: •incision or to slash the wound with a knife •or try to suck out the venom •Sterile dressing • -