1. 1 القرآنوالذكروالاستغفار أدوية ناجحة لكل كدر وضيق بسم الله الرحمن الرحيم

2. 2 General management of poisoning –What is Toxicology –What is a poison poison is any product or substance that can harm someone if it is used in the wrong way.in the wrong way. by the wrong personby the wrong person or in the wrong amount.or in the wrong amount.

3. 3 Examples of possible poisons include, some household products some household products chemicals at work or in the environment chemicals at work or in the environment drugs (prescription, over-the-counter, herbal). drugs (prescription, over-the-counter, herbal). Snake bites, spider bites, and scorpion stings Snake bites, spider bites, and scorpion stings

4. 4 Classification of poison 1-According to their mode of action: Poisons with local action: Poisons with local action: Poisons with remote action: Poisons with remote action: Poisons with both local and remote actions Poisons with both local and remote actions 2-According to the organs affected hepatotoxic – cardiotoxic- nephrotoxic 3-According to the chemical nature: Acidic poison – organic -etc Acidic poison – organic -etc

5. 5 Factors affecting the action of poisons: Age of the person Age of the person Personal hypersensitivity Personal hypersensitivity Tolerance Tolerance Idiosyncrasy Idiosyncrasy State of health State of health

6. 6 Factors affecting the action of poisons: Condition of the stomach Condition of the stomach Synergism Synergism State of the poison State of the poison Methods of administration Methods of administration Dose of the poison: Dose of the poison:

7. 7 Diagnosis of Poisoning 1- History and circumstantial evidences: 2- Clinical picture (signs and symptoms): Contracted pupils in morphine, organophosphorous, Contracted pupils in morphine, organophosphorous, Dilated pupils in atropine, cocaine, Dilated pupils in atropine, cocaine, Red skin in carbon monoxide and cyanide poisoning. Red skin in carbon monoxide and cyanide poisoning. Flushed face in atropine and alcohol poisoning Flushed face in atropine and alcohol poisoning Patches around the mouth in corrosives. Patches around the mouth in corrosives. Characteristic smell of the mouth Characteristic smell of the mouth Fever in atropine, salicylate, antidepressants. Fever in atropine, salicylate, antidepressants. Convulsions in oxalic acid, strychnine, ergot, insecticides Convulsions in oxalic acid, strychnine, ergot, insecticides

8. 8 3- Radiopacity of poisons There are a number of tablets with different chemical compositions that exhibit varying degrees of Radiopacity. Barium, Barium, Enteric coated tablets, Enteric coated tablets, Tricyclics antidepressants, Tricyclics antidepressants, Antihistamines, Antihistamines, Heavy metals Heavy metals

9. 9 4- Chemical analysis: The most important evidence of poisoning is by chemical analysis. ِِِ A- In the living: Samples are taken from vomit, gastric lavage, blood, urine and stool. B- In the dead : Blood from the heart or femoral vein. Blood from the heart or femoral vein. Stomach and its contents and parts of the intestines Stomach and its contents and parts of the intestines Parts of the liver, kidney, brain, lung Parts of the liver, kidney, brain, lung

10. 10 Screening tests These are various tests to evaluate the type (and roughly measure the amount) of legal and illegal drugs a person has taken. These are various tests to evaluate the type (and roughly measure the amount) of legal and illegal drugs a person has taken.

11. 11 General treatment of poisoning There are eight essentials of overdose management that may be considered for the patients with poisoning. All or some of them may be used for the patient according to his clinical state. There are eight essentials of overdose management that may be considered for the patients with poisoning. All or some of them may be used for the patient according to his clinical state. 1. Decontamination 2. Supportive care. 3. Prevent further exposure to the poison. 4. Removal of the unabsorbed poison from the stomach. 5. Inactivation of the poison remaining in the stomach. 6. Enhancement of excretion. 7. Administration of an antidote. 8. Symptomatic treatment.

12. 12 1-DECONTAMINATION Skin Skin 1. Wear protective clothes & gloves 2. Remove the patient ’ s contaminated clothing 3. Flush exposed areas with copious quantities of water

13. 13 Eyes: Corrosive agents Corrosive agents Toxins that are readily eye absorbed Toxins that are readily eye absorbed 1. Flush exposed eyes with copious quantities of water or saline 2. check the pH of the tears 3. Do not instill any neutralizing solution

14. 14 Inhalation: Irritating gases and fumes e.g. chlorine gas. Irritating gases and fumes e.g. chlorine gas. Toxin that are absorbed through the respiratory tract Toxin that are absorbed through the respiratory tract 1. Remove the victim from exposure 2. Observe for evidence of upper respiratory edema 3. Administer humidified 02

15. 15 2-Supportive care A large group of acutely poisoned patients can be treated with supportive care. The drug will be progressively eliminated over the next 12 to 36 hours in most patients, and usually this is all the care that is necessary. A large group of acutely poisoned patients can be treated with supportive care. The drug will be progressively eliminated over the next 12 to 36 hours in most patients, and usually this is all the care that is necessary.

16. 16 3-Prevent further exposure to the poisons Suicidal cases must be hospitalized Suicidal cases must be hospitalized In industrial or agricultural exposure In industrial or agricultural exposure In cases of toxic inhalants In cases of toxic inhalants

17. 17 4-Removal of the unabsorbed poison 1- Emesis (chemical – mechanical ) (chemical – mechanical ) Contraindication Contraindication 2- Gastric lavage Contraindication of gastric lavage Contraindication of gastric lavage

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24. 24 5- Inactivation of poison remaining in the stomach 1-Physical antidotes (demulcents – Diluents – Adsorbing ) 2-Chemical antidotes A- precipitating antidotes B- Oxidizing antidotes C-Reducing antidotes

25. 25 Household antidotes Substances that are available Substances that are available in a house and can be used as a first aid treatment of poisoning What do u think ? What do u think ?

26. 26 6-Enhancement of excretion Poisons eliminated through the lung Poisons eliminated through the lung (in expired air) (in expired air) Poisons excreted through intestine (in stool) Poisons excreted through intestine (in stool) (purgatives ) Poisons excreted through bile e.g. morphine Poisons excreted through bile e.g. morphine (Multiple-dose activated charcoal (

27. 27 Poisons excreted by the kidney (in urine)Poisons excreted by the kidney (in urine) 1. Fluid diuresis 2. Forced diuresis Forced osmotic dieresis Forced acid diuresis Forced alkaline diuresis 3. Hemodialysis (artificial kidney) 4. Peritoneal dialysis:

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30. 30 7- Administration of physiological antidote if available Diazepam in strychnine poisoning. Diazepam in strychnine poisoning. Atropine in organophosphorous (antagonize muscarinic action). Atropine in organophosphorous (antagonize muscarinic action). Pilocarpine - peripheral action of atropine Pilocarpine - peripheral action of atropine  BAL (British antilewisite) in arsenic. EDTA (Ethylene Diamine Tetra-Acetate ) EDTA (Ethylene Diamine Tetra-Acetate ) Naloxone in morphine poisoning Naloxone in morphine poisoning

31. 31 8- Symptomatic treatment. 8- Symptomatic treatment. 1- coma : Definition Definition Grades Grades Treatment Treatment

32. 32 2- Shock Definition BP Treatment

33. 33 3- Respiratory failure Definition Definition Diagnosis (Blood Gases ) Diagnosis (Blood Gases ) Treatment Treatment

34. 34 4- Acid – base disturbances Definition Definition Diagnosis (Blood Gases - PH ) Diagnosis (Blood Gases - PH ) Treatment Treatment

35. 35 5- Convulsion Definition Definition Differential Diagnosis Differential Diagnosis Treatment Treatment

36. 36 6- Disturbances in body temp Hypothermia Hypothermia Rectal temperature is below 36ْC, treat the patient in warm room & wrapping with blankets Hyperthermia Hyperthermia Keep the patient in a cool, well ventilated room, ice bag, antipyretics and antibiotics may be needed.

37. 37 جزآكم الله خيرا