Welcome back to the 286 podcast. For this episode, I will be covering uh the different poisonings. So, common types of poisoning are going to be your corrosives, acids, and medications. Uh corrosives can be alkaline. These include things like lie drain cleaners, toilet bowl cleaners, bleach, and then button batteries, like the batteries that go in watches and hearing aids, cameras, the little small flat circle ones. Uh, your acidic corrosives are going to be things like pool cleaners, rust removers, uh, battery acid, metal cleaners, and then your common medications that result in overdoses and poisonings are acetaminophen, NSAIDs, psych meds, and blood pressure meds. For your clinical manifestations here, if it's a medication overdose, expect your medication side effects, but just really exaggerated. Like imagine your blood pressure medications. Now your patient's extremely hypotensive. For ingested corrosives or acids, your patient may have um burning sensations, oral redness or burns, dysphasia, difficulty swallowing, painful swallowing, vomiting, and drooling. Uh so the main things that we want to do here remove or inactivate um the substance before it can be absorbed provide supportive care for any damaged organs uh administer antidotes or reversal agents and then help the body to eliminate the poison. Toxidrome is a syndrome or a group of signs and syndromes associated with overdoses or exposures to a particular category of drugs and toxins like you can see antiolinergics, opioids and the like. For your um antidotes for these your antiolinerics, this is going to be uh fsosticamine. For your chonergics, we do atropene and uh prolax. For opioid agents, obviously you should know this is your narcan nlloxxone and then for your sympathetics. Unfortunately, there is no true um antidote available for these. So we treat with supportive measures. Uh commonly we're going to give bzzoipines because as you can see agitation and seizures are among the signs and symptoms here. And how do we treat agitation and seizures? We give bzzoazipines. As far as um management of your poisons, we need to figure out what the ingested substance was. Was it medication? Was it some sort of cleaner? If it was exposure with um or in the eyes, we flush the eyes with water or normal saline. We may need to do continuous flushing for up to 15 minutes. And we're going to instruct the patients to blink their eyes a whole bunch while we are um irrigating the eyes just to flush the substance out, create their own tears. Please call poison control. These are going to be your BFFs while uh you're treating your patient uh who has experienced an overdose or a poisoning. Um they have all of the algorithms and all of the evidence-based practice at their fingertips. So this is the person that um you want to talk to. Uh they may also call for updates, ask for labs. It's not a HIPPO violation. It they are healthcare providers to an extent. So we want to make sure that um we are providing all the same information. Give our antidotes if it's applicable. Uh for dilution, we can use water or milk. Uh we're going to use 8 ounces of milk or water for adults. And then between 2 and 8 ounces of milk or water for kids depends on their size. Gastric lavage. Uh this is your stomach pumping. We aspirate the stomach contents through that NG tube. If um airway protection is needed from a result of the poisoning, we can intubate our patient and put an OG tube in. Does the same thing. It's best if your patient is in the LA uh left lateral position. We're going to put in 150 to 200 milliliters of warm saline into the stomach and then let it return via gravity. We're only um we're going to do this until there's uh 2 L of to 2 L total of fluid has been instilled and then we want that to run clear. uh when we are getting that return. We can only do gastric lavage though if it's been less than an hour since the patient has ingested the material. If we do this, we actually save the aspirate and we send it to lab for toxicology screening. If uh the toxin is circulating then we need to do dialysis and this may be also a result of what the poison has caused. So uh electrolyte imbalances, hyperclemia, anything that we may need to filter the blood and protect the kidneys. We want strict eyes and O's as well. Um especially watching for any kidney damage. We can do an inddwelling catheter. We want to monitor again for kidney function. continuous cardiac monitoring. Uh and we do not want our patient to vomit. Uh some other measures that we can do, we can give activated charcoal. If whatever the patient has ingested is absorbed by charcoal, we can give this orally or through that same NG tube, OG tube. It's best if it's given in small intermittent doses because this helps prevent vomiting. We don't want our patient to vomit uh because this can cause esophageal irritation. Can also have our patient drink it through a straw if they're alert and oriented. Um it's not going to be effective for corrosive. So just make sure that whatever the substance was, it's been identified so that we're not uh doing useless treatments. your supportive measures, fluids, oxygen, um monitoring and replacing electrolytes if needed, and then also looking for any of those acid base imbalances. We covered this in class, so hopefully you gathered it. If not, quick Google search is going to get you filled out with this table, right? for your carbon monoxide poisoning. Uh some of your clinical manifestations here, this is going to be an elevated caroxyhemoglobin level. When carbon monoxide attaches to hemoglobin, it is now called caroxyhemoglobin. Your normal is less than 1.5%. Mild carbon monoxide poisoning is going to be 10%. This is when we see no clinical manifestations. Sometimes your smokers are going to be able to tolerate a higher level and take a longer time and a higher level to start showing signs and symptoms. But we consider carbon monoxide poisoning at 15% uh caroxyhemoglobin saturation. CNS symptoms like cerebral hypoxia are the most common symptoms that are seen because the brain is really sensitive to that drop in circulating oxygen. So your patient may appear intoxicated. They may be dizzy, restless, confused and then as the saturations of caroxyhemoglobin increase, you could also see your patient um in seizures, comas and then resulting in death. Patient could also have palpitations as a result of myioardial hypoxia. As far as our nonreliable findings, skin color is not a reliable finding. Um, because your patient can be pink, cherry red, cyanotic, pale, different uh skin colors mean so many other things and it's not specific to carbon monoxide poisoning. So we can't really say that it is a reliable indicator because your patient could also have different colors of skin depending on their levels of caroxyhemoglobin saturation. And then high oxygen saturation is also not considered a reliable finding because carbon monoxide is going to attach to hemoglobin. Hemoglobin has a higher affinity for carbon monoxide than it does for oxygen. So it wants to hold on to uh carbon monoxide more than it wants to hold on to oxygen. All your uh pulse occimmetry is measuring is the amount of hemoglobin that are saturated. Not saturated with oxygen, just saturated. So if all of your hemoglobin are saturated with carbon monoxide, your pulse occimmetry is going to show 100%. So this is why it's not a reliable factor for our interventions here. Uh we want to move our patient into fresh air, get them away from the carbon monoxide, open windows, doors, uh loosen any tight clothing. We may need to initiate CPR if needed, provide assisted ventilation. Uh your patient could have respiratory depression or they could go into respiratory arrest. We want to prevent chilling. Uh carbon monoxide is going to cause vasoddilation which is going to cause your patient to lose heat. So they may be shivering. We don't want our patients to smoke. And we want to monitor that caroxyhemoglobin level. We're going to give 100% oxygen via non-rebreather until the caroxyhemoglobin is between 5 and 10% or less. But as always, follow facility protocol. And then if it's high enough for too long, we may see any signs of uh permanent brain damage like psychosis, atexia, visual disturbances, behavior changes. So there's some things to be aware of. And that's going to be it for all of your poisoning.