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How to Treat Exposure To Poisonous Substances?


Things to note:
  • Limit further poison exposure.
  • Take a thorough and accurate history, find out all relevant facts and do a thorough clinical exam. A high suspicion index is important.
  • Get a background, particularly for patients with impaired consciousness. There should be a special effort in obtaining tablets, packets, containers, etc. Identify participating agents.
  • Wash the body and remove clothes in case of exposure to the skin. Dushing can be helpful.
  • Remove eye contaminants, especially alkalis, acids, and other irritants, for 15- 20 minutes through continuous eye irrigation.
  • Gastric lavage is inefficient unless it is ingested within an hour. It is contraindicated when corrosive substances and volatile hydrocarbons like paraffin are ingested. It should only be done in patients with reduced awareness if the airways are protected.
  • Limit research into toxicology to those which may influence/alter management.
Maintaining and monitoring basic clinical parameters, i.e:
  • Pulse rate,
  • Blood pressure,
  • Hydration,
  • Ventilation,
  • Patent airway and oxygenation and
  • Control and prevention of physical injury in an agitated manner.Avoid oversedation.

When to refer:
  • Severely ill patient for ventilatory/circulatory support.
  • Relevant diagnostic testing not available, e.g. paracetamol levels.
  • Relevant medication/antidote not available.
  • Dialysis/haemoperfusion required.
  • For psychiatric evaluation.