Poisoning hospital care

Field First Aid Remove victim(s) to an area of safety (away from the Hot Zone). Remember patients may contaminate you and/or other emergency responders if you fail to don proper personal protective equipment. Provide victims with emergency medical care as soon as possible. Unless otherwise recommended, remove victim(s) clothing, shoes, and personnel belongings for later return. If the victim was obviously in contact with infectious substance(s), flush skin and eyes for fifteen to twenty minutes. Route victim(s) to hospital for a physician s professional opinion. Ensure that hospital staff is fully aware of the medical situation and the poison or infectious substance that may be involved. An enzyme-linked immunosorbent assay test (ELISA) is now approved for anthrax use in hospital laboratories. 

DELAYED A delayed casualty is one who needs further medical care but can wait for that care without risk of compromising successful recovery. That person may require extensive surgical procedures and long-term hospitalization, but is presently stable and requires no immediate care. A casualty with a leg wound or fracture is an example of a conventional casualty who would be delayed. A casualty recovering from severe nerve agent poisoning will be delayed. Most casualties with vesicant burns will be delayed. 

As with amatoxin poisoning, attempts to remove the toxin from plasma by extra-corporal purification methods at the time of hospitalization do not seem promising because of the long latent period. However, beside supportive care, hemodialysis is the option during the clinical course. For a recent review on Corinarius spp. poisoning, see Danel et al. (2001). A renal transplantation should not be carried out too early the mean time for a transplant among the cases published so far was 6 to 30 months. 

Because many of these cases are suicides, it may be necessary to exercise precautions to prevent future attempts while at home or in the hospital. Supportive management entails carefully noting the clinical and laboratory parameters of improvement while looking actively for any complications of the poisons as well as from the therapy instimted to save the patient s life. Psychiatric evaluation is often necessary in these cases. 

Even with a serious exposure, poisoning is rarely fatal if the victim receives prompt medical attention and good supportive care. Careful management of respiratory failure, hypotension, seizures, and thermoregulatory disturbances has resulted in improved survival of patients who reach the hospital alive. 

Emergency treatment depends on the immediate toxic effects of BZP and TFMPP. High blood pressure, abnormal heart rate or rhythm, seizures or convulsions, fever, and abnormal movements all have specific treatments and may require hospitalization for intravenous medications and general supportive care. Coma or decreased level of consciousness, respiratory depression, difficulty breathing, and severe allergic reaction may require treatment in an intensive care unit and assisted respiration. If a user experiences any untoward effects, or if someone inadvertently takes a much larger dose of medicinal piperazines than prescribed, it is prudent to contact a doctor, emergency medical services, or poison control. 

Fonseka MM, Senevirame SL, de Silva CE, Gunatilake SB, and de Silva HJ (2002) Yellow oleander poisoning in Sri Lanka Outcome in a secondary care hospital. Human Experimental Toxicology 21(6) 293-295. 

Poisoning emergencies are a common occurrence. In 2002, The Toxic Exposure Surveillance System of the American Association of Poison Control Centers reported 2 380028 toxic exposures and 1153 resultant fatalities. Of these total exposures, 548 093 (22.2%) were managed in a healthcare facility and 72 877 were admitted to a critical care unit (3.1%). The mortality rate associated with these overdose patients was less than 1%. Thorough evaluation, adequate supportive care, and the use of a few specific antidotes have resulted in lowered morbidity and mortality if the poisoned patient arrives at the hospital in time for the healthcare team to intervene. In select cases, decreasing further toxin absorption by various decontamination procedures may be of benefit. 

Determining the number of beds in every hospital, where patients will be taken after mass poisonings, the severest cases being hospitalized in reanimation and intensive care units, the others - in children (for injured children), internal diseases and other hospital sections. 

Due to the lack of gas masks and other protective clothes and gear, the total number of victims poisoned with sarin in Matsumoto who needed professional help (600) included not only residents, but also members of the rescue team and health care professionals. Seven out of 58 residents admitted to the hospitals died. A physician from the duty ambulance vehicle and seven rescuers out of the 95 engaged, had mild symptoms of organophosphate intoxication [13],... 

Treatment of a person poisoned by ricin involves alimentary canal decontamination procedures so as to prevent absorption of the toxin. These include the use of syrup of ipecac to induce vomiting, activated charcoal to adsorb the toxin and cathartics to accelerate expulsion. Where a suspected poisoning has occurred but the patient remains asymptomatic, alimentary canal decontamination should still be undertaken and hospital observation for at least six hours after suspected poisoning should take place. The patient should be told to return immediately if symptoms begin. Where more severe poisoning has occurred treatment with intravenous fluids, monitoring for haemolysis and hypoglycaemia, supportive care and the possibility of hypovolaemia should be considered. 

A casualty from exposure to a lethal amount of cyanide will die within a few minutes if he receives no therapy. If antidotes are given in time, he will recover with no serious adverse effects or sequelae to interfere with wound care. One of the antidotes, sodium nitrite, causes vasodilation and orthostatic hypotension, but these effects are short and should not be factors in overall patient care. If a casualty with a conventional wound and severe effects from cyanide poisoning presented at the unit-level MTF (or even at a major hospital), the procedure would be to give the antidote immediately. If the effects of cyanide are reversed, he should receive further care. Incapacitating Agents... 

Cyanide poisoning is treated with specific antidotes and supportive medical care in a hospital setting. The most important thing is tor victims to seek medical treatment as soon as possible. 

Florida Poison Information Center-Miami, University of Miami/Jackson Memorial Hospital, 1611 NW 12th Avenue, Urgent Care Center Bldg., Rm. 219, Miami, FL 33136... 

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