injuries and poisoning
Overview of Poisoning
Treatment of Poisoning
Some people who have been poisoned must be hospitalized. With prompt medical care, most recover fully. The principles for the treatment of all poisonings are the same: Support vital functions such as breathing, blood pressure, body temperature, and heart rate Prevent additional absorption Increase elimination of the poison Give specific antidotes (substances that eliminate, inactivate, or counteract the effects of the poison), if available Prevent reexposure The usual goal of hospital treatment is to keep people alive until the poison disappears or is inactivated by the body. Eventually, most poisons are inactivated by the liver or are passed into the urine. Poisoning often requires treatment, termed supportive care, to stabilize the heart, blood pressure, and breathing until the poison disappears or is inactivated. For example, a person who becomes very drowsy or comatose may need a breathing tube inserted into the windpipe. The tube is then attached to a Mechanical Ventilation , which supports the person’s breathing. The tube prevents vomit from entering the lungs, and the ventilator ensures adequate breathing. Treatment also may be needed to control seizures, fever, or vomiting. If a poison causes a high fever, the person may need to be cooled, for example, with a cooling blanket, or sometimes by applying cool water or ice to the skin. If the kidneys stop working, Hemodialysis is necessary. If liver damage is extensive, treatment for Poisons in the eyes or on the skin usually should be washed off with large amounts of salt (saline) solution, or tap water. Sometimes soap and water is used on the skin. Very few swallowed poisons are absorbed so quickly that measures cannot be tried to keep them out of the bloodstream. However, such measures are effective only for certain poisons and situations. Stomach emptying(inducing vomiting or stomach pumping), once commonly done, is now usually avoided because it removes only a small amount of the poison and can cause serious complications. Stomach emptying rarely improves a person's outcome. However, stomach pumping may be done very rarely if an unusually dangerous poison is involved or if the person appears very sick. In this procedure, a tube is inserted through the mouth into the stomach. Water is poured into the stomach through the tube and is then drained out (gastric lavage). This procedure is repeated several times. If people are drowsy because of the poison, doctors usually first put a plastic breathing tube through the mouth into the windpipe (endotracheal intubation). Endotracheal intubation helps keep the gastric lavage liquid from entering the lungs. Doctors often used to give syrup ofipecac, a drug that causes vomiting, to children who swallowed poisonous substances. However, this treatment did not often remove significant amounts of the swallowed substance. Now doctors useipecaconly for substances that are highly toxic and when it would take a long time to get the person to the emergency department. In the hospital, doctors do not give syrup ofipecacto empty the stomach because its effects are inconsistent. Activated charcoalis sometimes given in hospital emergency departments to people who have swallowed poisons. Activated charcoal binds to the poison that is still in the digestive tract, preventing its absorption into the blood. Charcoal is usually taken by mouth if the person is alert and cooperative. Introducing activated charcoal through a tube placed in the nose or mouth in people who are either uncooperative or lethargic is not recommended. Sometimes doctors give charcoal every 4 to 6 hours to help cleanse the body of the poison. Not all poisons are inactivated by charcoal. For example, charcoal does not bind alcohol, iron, or many household chemicals. Whole-bowel irrigationis a treatment method designed to flush a poison from the digestive tract. It is used only occasionally, for example, for serious poisoning caused by poisons that get stuck in the digestive tract or need to be moved physically (such as packets of hidden, smuggled drugs) or poisons that are absorbed slowly (such as some sustained-release drugs) or not absorbed by activated charcoal (such as iron and lead). If a poison remains life threatening despite the use of charcoal and Antidotes , more complicated treatments that remove the poison may be needed. The most common treatments are hemodialysis and charcoal hemoperfusion. Hemodialysis None , a person's blood is passed over activated charcoal to help eliminate the poisons (see table Hemofiltration and Hemoperfusion: Other Ways of Filtering the Blood ). For either of these methods, small tubes (catheters) are inserted into blood vessels, one to drain blood from an artery and another to return blood to a vein. The blood is passed through special filters that remove the toxic substance before being returned to the body. Alkaline diuresisis sometimes used. With this procedure, a solution containingsodium bicarbonate(the chemical in baking soda) is given by vein to make the urine more alkaline or basic (as opposed to acidic). This can increase the amount of certain drugs (such asaspirinand barbiturates) excreted in the urine. ( Treatment ) and opioids such as heroin and People who attempt Suicidal Behavior by poisoning need mental health evaluation and appropriate treatment. 