-Toxic Causes of respiratory Failure.

Toxic Causes of respiratory Failure

1-Central:-

• Alcohol
• Barbiturate
• Opiate

2-Peripheral:-

A-Airway obstruction:-

• Falling back of the tongue.
• Vomitus.
• Excessive Secretions e.g Organophosphurus,carbamate.
• Oedema of the air way e.g Irritant fumes,Chlorine gas.
• Laryngeal spasm (Cyanide).
• Pneumonia(Hydrocarbon aspiration).
• Bronchospasm(Organophosphurus).
• Pulmonray
• oedema(Organo-phosphurus).

b-Paralysis of respiratory muscles:-

• Botulinum toxins.
• Snake bite.
• post-convulsion muscle exhaust.
• Organophosphurus.

C-Neuromuscular blocker:-

Physostigmine,Neostigmine.

Dr Ibrahim

-Poisons with charachteristic odour.

Poisons with charachteristic odour

"Phenol"

Phenol,Phosphorus.

Hydrocarbons.
Hydrocyanic acid(Bitter almond).
Hydrogen sulphide(Rotten egg).

Ethanol and methanol.
Nicotine.

Opium.
Organophosphorus,arsenic (Garlic odour).

Liquid of salicylate"oil of winter green".

Dr Ibrahim

-Indications of heamodialysis.

Indications of heamodialysis
"Unstable"

Uraemia.
No response to conventional therapy.
Salicylates.
Theophylline.
Alcohols,Acetaminophen.
Boric acid,Barbiturates.
lithium.
Ethylene glycol.

Dr Ibrahim

-Substances not adsorbed by Activated Charcoal.

Substances not adsorbed by Activated Charcoal
"Phials"

Pesticide,potassuim
Hydrocarbons.
Iron,Insecticide.
Acids,Alkali,Alcohols.
Lithium.
Solvents.

Dr Ibrahim

-Common radiopaque medications.

Common radiopaque medications which appear in X-ray
"Cheap bit"

Chloral hydrate,Cocaine,Ca.
Heavy metals.
Enteric coated tablets.
Antihistamines,Arsenic.
Phenothiazines,potassium.

Barium.
Iodide,Iron.
Tricyclic antidepressants.

Dr Ibrahim

-Don't soil scorpion sting.

Don't soil(تلوث)scorpion sting

(Don't perform the following in scorpion sting):-

Suction of the wound.
Over treat by hypnotics (over sedation).
Immersion of injured extremity in ice.
Local incision.

Dr Ibrahim

-Poisoning severity grading.

Poisoning severity grading

Grade 0(none):no symptoms or signs or vague symptoms not related to the poison.

Grade 1(Minor):Mild,transient and spontanously resolving symptoms.

Grade 2(Moderate):pronounced or prolonged symptoms.

Grade 3(sever): sever or life threatening symptoms.

Dr Ibrahim

Return to list of medical grades (click here) 

- Gastric Lavage.

- Gastric lavage:- also commonly called Stomach wash or Gastric suction, is the process of cleaning out the contents of the stomach. It has been used for eliminating poisons from the stomach.

- Indications:-

1. With patient has ingested a potentially life-threatening amount of a poison and the procedure can be undertaken within 60 minutes of ingestion.
2. Cleaning the stomach before an upper endoscopy in someone who has been vomiting blood.
3. Collecting stomach acid for tests.
4. Relieving pressure in someone with a blockage in the intestines.

- Contraindications :-

1. Loss of airway protective reflexes, such as in a patient with a depressed state of consciousness.
2. Ingestion of a corrosive substance such as a strong acid or alkali.
3. Ingestion of a hydrocarbon with high aspiration potential.
4. Patients who are at risk of hemorrhage or gastrointestinal perforation due to pathology, recent surgery, or other medical condition, that could be further compromised by the use of gastric lavage.

- Complications:-

• Aspiration pneumonia.
• Laryngospasm.
• Hypoxia and hypercapnia.
• Mechanical injury to the throat, esophagus, and stomach.
• Fluid and electrolyte imbalance.
• Struggling patients may be at greater risk of complications

- Technique:-

1. Gastric lavage involves the passage of a tube via the mouth or nose down into the stomach, followed by sequential administration and removal of small volumes of liquid.
2. The placement of the tube in the stomach must be confirmed either by air insufflation while listening to the stomach, by pH testing a small amount of aspirated stomach contents, or x-ray. This is to ensure the tube is not in the lungs.
3. Lavage is repeated until the returning fluid shows no further gastric contents.
4.  If the patient is unconscious or cannot protect their airway then the patient should be intubated before performing lavage.

- Finally there is video which learn you how to perform gastric lavage...

video: Nasogastric Intubation from New England Journal of Medicine..

Watch the video online.

Download - Windows Media version.

Dr Ibrahim

- Investigations for diagnosis of poisoning.

Investigations for diagnosis of poisoning

There are general & toxicological measures ......

• ECG.
• Urea & electrolytes , lab glucose, anion gap /- lactate & osmolal gap.
• Liver function Tests & Clotting (paracetamol, anticoagulants).

• Arterial Blood Gases.

• Drug levels (at appropriate interval: Paracetamol, salicylates; others: theophylline, digoxin, lithium, anti-epileptics if it was likely that they had been taken).

• Comprehensive toxicology screens not normally indicated in the emergency treatment.
• Carboxyhaemoglobin levels if carbon monoxide suspected.
• Urinalysis , save sample for possible toxicological analysis.

• Rhabdomyolysis , save sample for possible toxicological analysis.

• Chest X-Ray if pulmonary oedema/aspiration suspected.

- Types of Poisoning.

• Deliberate متعمد
  
  • Overdose as self-harm or suicide attempt.إنتحار
  • Child abuse .
    
  • Munchhausen's syndrome :Factitious disorder, Hospital addiction syndrome(e.g psychic patient).
  • Third party (attempted homicide, terrorist, warfare).
  
  
• Accidental عن غير قصد
  • Most episodes of paediatric poisoning.
  • Dosage error.
  • Iatrogenic
  • Patient error
  • Recreational use.
  
  
• Environmental:
  • Plants
  • Food
  • Venomous stings/bites.
  
  
• Industrial exposures.

- Paracelsus said...

" All substances are poisons;

there is none which is not a poison.

The right dose differentiates

poison from remedy ".

Paracelsus (1493-1541)