Poisonings in children
Transcript of Poisonings in children
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PRESENTED BYPRESENTED BY
MALAR KODI. SMALAR KODI. S
M.SC (N) II YEARM.SC (N) II YEAR
DR.SYAMALA REEDY COLLEGE OFDR.SYAMALA REEDY COLLEGE OFNURSINGNURSING
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National poison information centre india
Reported 30.6% of poisoning in
children.
In that oral poisoning was 96.8%dermal exposure was 3.2%
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How poison gets into the body
Through,
Mouth (ingestion)
Lu
ngs (inhalatio
n) skin (injection)
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Example for poisons are
Pesticide
Windshield washer fluid
polish
PlantsPaint thinner
Cigarettes
Kerosene
Lamp oilToilet bowl cleaners
lead
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unintentional ingestions by toddlers
Suicide attempt by adolescents
lead poisoning in children in old
housesDaily pesticide exposure in
children living on farms
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PATTERN OF POISONINGPATTERN OF POISONING
Chemical products, mostoftenswallowed by children includehousehold cleaners (bleach, detergents)fuel (kerosene, paraffin), cosmetics,
medicines, paints and products forhousehold repairs and householdpesticides.
Bites and stings ofanimals and insects,and ingestion ofpoisonous plants andseeds also considerably accountforoutdoor poisoning in children.
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Ecology of poisoning
Interaction between the host and theenvironment (including easy access tothe poisonous substances) determinesthe magnitude ofthe problem.
Age. About 40% ofall cases ofaccidental poisoning in children arereported in the second yearof life;about 12% ofthe cases occur in the first
and 20% inthe
third year. Hyperac
tivemale children are more prone to
accidental poisoning.
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Continued.
Small accommodation
Environment:Lead poisoning iscommon in children living in areas were thereare workshops for automobile, lead storagebatteries orfor manufacture of lead typesetsfor printing presses. Rural or Urban areas:
The pattern of poisoning varies inrural and urban areas due to exposures todifferenttypes ofpotential poisons. Snakebites
are more common in those wandering in fields.Also pesticides are more common in rural setup. The poor are driven by starvation toexperimenton roots and fruits thus leading topoisoning.
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Continued..
Large families: In large families
mother is often too occupied with
household chores, is easily fatigued
and often careless in storage of
potentially poisonous household
substances.
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Classification of poisonsClassification of poisons
Based on the chiefsymptoms they
produce
Corrosives- strong acids, strong
alkalis, metallic salts.
Irritants- organic, inorganic.
Systemic- cerebral, spinal, peripheral,
CVS, asphyxiates.Miscellaneous- food poisoning etc..
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General signs and symptomsGeneral signs and symptomsGeneral signs and symptomsGeneral signs and symptoms
SymptomsSymptoms--odor, sweating, fever, delirium,convulsions, burns ofmouth, blindness,GI symptoms, abnormal movements,coma.
SignsSigns- blindness, facial twitching, dull& mask like expression, pallor,cyanosis, hypothermia, sweating,respiratory symptoms, CVS symptoms,
CNS symptoms.
SymptomsSymptoms--odor, sweating, fever, delirium,convulsions, burns ofmouth, blindness,GI symptoms, abnormal movements,coma.
SignsSigns- blindness, facial twitching, dull& mask like expression, pallor,cyanosis, hypothermia, sweating,respiratory symptoms, CVS symptoms,
CNS symptoms.
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History Taking
What poison was..
Ingested, Time since ingestion
Total amountofpoison ingested.Route ofexposure.
Progression ofsigns and symptoms sinceingestion.
Family history ofepilepsy, mental subnormality, bleeding disorder.Whetherthe patient is receiving othermedications which may interact with thepoison.
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Poisoning severity GradesPoisoning severity GradesPoisoning severity GradesPoisoning severity Grades
None(0)- no symptoms or signs/vaguesymptoms judged notto be related topoisoning.
Minor(1)- Mild, transient & spontaneouslyresolving symptoms.
Moderate(2)- pronounced or prolongedsymptoms.
Severe(3)- severe or life threatening
symptoms.
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First-Aid for Poisonings
swallowed poison:
If you find your with an open or emptycontainer of a toxic substance, your childmay have been poisoned. Stay calm and
act quickly
Get the poison away from the child.
If the substance is still in the child's mouth,make him/her spit it out or remove it withyour fingers (keep this along with any otherevidence of what the child has swallowed).
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Con
Do not make the child vomit (your child'sphysician or poison control center willinstruct you when it is necessary to makethe child vomit).
Do not follow instructions on packagingregarding poisoning as these are oftenoutdated; instead call your child's physician
or poison control center immediately forinstructions.
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Poison on the skin:
If your child spills a chemical on his/herbody, remove any contaminated clothes
and rinse the skin well with lukewarm - nothot - water. If the area shows signs ofbeing burned or irritated, continue rinsingfor at least 15 minutes, no matter how
much your child may protest. Then, call thepoison center for further instructions. Donot use ointments, butter, or grease on thearea.
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Poisoning FirstAid: DoNot
DO NOT give an unconscious victim anything bymouth.
DO NOT induce vomiting unless you are told to doso by the Poison Control Center or a doctor. A
strong poison that burns on the way down thethroat will also do damage on the way back up.
DO NOT try to neutralize the poison with lemonjuice or vinegar, or any other substance, unlessyou are told to do so by the Poison Control Centeror a doctor.
DO NOT use any "cure-all" type antidote.DO NOT wait for symptoms to develop if yoususpect that someone has been poisoned.
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Basic Management of aBasic Management of a
poisoned childpoisoned child
Antidotes are available for very feware available for very fewcommonly encountered poisons, andcommonly encountered poisons, andtreatment is usually nontreatment is usually non--specific andspecific and
symptomatic. In such cases managementsymptomatic. In such cases managementconsists of emergency first aid andconsists of emergency first aid andstabilization measures, appropriatestabilization measures, appropriatetreatment to reduce absorption, measurestreatment to reduce absorption, measuresto enhance life support followed byto enhance life support followed bypsychiatric counseling.psychiatric counseling.
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Continued
Neurological assessment is made by
calculating the Glasgow Coma Score
(GCS).
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Initial resuscitation stabilization
Includes airway- proper positioning head tilt and chinlift, suction ofsecretions from or pharynx, falling backoftongue is prevented by suitable airway tube.
Breathing- oxygen via a mask, when gag/cough reflects
is absent- ETtube inserted. ifnecessary positivepressure ventilation with ABG monitoring, respiratorystimulants for severe respiratory depression.
Circulation- properIV access, maintenance offluid &electrolyte balance, IV drugs fortreatment.
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Symptomatic & supportive
Management
Homodynamic supportHomodynamic support-- elevation ofelevation offoot end ofthe bed, oxygenfoot end ofthe bed, oxygenadministration, IVfluids, bloodadministration, IVfluids, bloodproducts.products.
Cardiac dysrrhythmiasCardiac dysrrhythmias-- correctioncorrectionofhypoxia, acidosis, hypokalemia,ofhypoxia, acidosis, hypokalemia,ECG, treatment with antiarrhythmicECG, treatment with antiarrhythmicdrugs.drugs.
ConvulsionsConvulsions-- correction ofcorrection ofhypoglycemia/hypocalcaemia/hypohypoglycemia/hypocalcaemia/hypoxia/cerebral edema and otherxia/cerebral edema and othermetabolic defects, anticonvulsantmetabolic defects, anticonvulsant
therapy.therapy.
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Continued.
Dermal decontamination.
Absorption oforgan phosphorus
and related compounds through
cutaneous route can prove to be a
fatal as oral route absorption.
Cutaneous absorption depends on
several factors such as lipidsolubility, skin condition, location,
caustic effect, physical conditions
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Continued.
Gut decontamination. This
includes
(i) gastric evac
uatio
n;(ii) adsorbent administration;
(iii) catharsis. Emesis is the
preferred me
tho
dof
emptying
thestomach in conscious children.
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Gastric evacuation (Emesis)
Vomiting can be induced bytickling the faces with a finger, featheror a leafy twig ofa tree;
administration ofcopious draughts of
warm water;gurgling with non-detergent soap; or
saline emetics in warm water. Toprevent aspiration in small children, thehead should be kept low.
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Continued..
Syrup of ipecac may be used for inducingemesis in children olderthan 6 months in asingle dose of10 ml for 6-12 months age, and15 ml for children above 1 yearofage. The
dose may be repeated in 20 minutes forthosemore than 1 yearofage.
Induction ofvomiting is contraindicated incorrosive or kerosene poisoning and in
comatose patients orthose with absent gagreflex.
GATRICLAVAGE
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CATHARSIS
Laxative and purgatives may be
given in poisoning. Commonly used
are sorbital and monnital(1-2g/kg)and megnesium orsodium
sulfate(200-300g/kg)
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PROMOTION OF EXCRETION
POISONING
PROMOTION OF EXCRETION
POISONING
FORCED DIURESIS.
HEMODIALYSIS.
PERIDONEAL DIALYSIS.
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Specific Antidotal Therapy
The antidotes may be physiological, chemicalor physical. Chemical antidotes combine withthe poison and render it innocuous.
Physiological antidotes counteractthe effectsofthe poison on the metabolism andphysiological functions ofthe body and thusprevent its harmful effects. Physical antidotespreventthe contactofthe poisonous
su
bstance wi
ththe
targe
to
rgano
r adso
rbthetoxic components, thus preventing their
toxicity.
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Common antidote used
TOXIN ANTIDOTES
1.Anticholinergics physostigmine2. Acetaminophen N-acetylcystein
3.carbon-monoxide Oxygen
4.Cyanide Sodium nitrite
5. Iron salts Deferral
6. Narcotics Naloxone7.Organophosphates Atropine
8.Isoniazid Pyridoxine.
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CONTINUED
Treatthe convulsion with diazepamand midozolam.
Renal failure maintained by
standard protocolInfection should be treated withantibiotics
Fever and pain are relieved withantipyretics and analgesics.
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Prevention of poisoning (PENSE)Prevention of poisoning (PENSE)
-Protection of the child from the
poisonous substances.
-Education of parents.
Need for parental supervision.
-Safety regulation.
-Establishment of poison control centers.
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ANY QUESTION?
?