This powerpoint deals with a part of general principles in the management of poisoning. Mainly deals with AIRWAY and BREATHING related problems.

1. GENERAL PRINCIPLES INVOLVED IN
MANAGEMENT OF POISONING- I
Dr. Vishnu R Nair,
PharmD, RPh, Dip. (Nutrition),
Assistant
Professor (Dept. of Pharmacy
Practice),
NIMS Institute of
Pharmacy.

2. WHAT IS CLINICAL TOXICOLOGY?
 Branch of science, that deals with PATLET of
poison/poisoning
 PATLET means:
i. P: Properties of poison
ii. A: Action of poison
iii. T: Toxicity of poison (poisoning features)
iv. L: Lethal dose
v. E: Estimation (How to confirm a particular
poisoning?)
vi. T: Treatment of the poisoning.
WHAT IS POISON?
Refers to any substance  injected into living body by any
means (oral, i.v, inhalation/ dermal)  causes local/systemic
effects (or even both)  results in ill-effects/ death of the
individual.

3. GENERAL PRINCIPLES OF
POISONING MANAGEMENT:
Includes the following major headings:
i. STABILIZATION & EVALUATION
ii. GUT DECONTAMINATION
iii. POISON ELIMINATION
iv. ANTIDOTE ADMINISTRATION
v. NURSING CARE
vi. PSYCHIATRIC CARE.
STABILIZATION & EVALUATION:
Refers to assessment & correction of life-threatening
problems associated with the poisoning
Always pay attention to ABCD of RESUSCITATION:
A: Airway
B: Breathing
C: Circulation
D: Depression of CNS.

4. AIRWAY:
 Causes of death from airway block:
i. Airway obstruction
ii. Pulmonary aspiration of gastric contents
iii. Respiratory arrest.
 Treatment involves:
i. Optimize airway position to force the flaccid tongue
out.
ii. Maximize airway opening (clear/suction airway)
iii. Perform endotracheal intubation (nasotracheal/
orotracheal)
iv. https://www.youtube.com/watch?v=qzIyTCx1Mfw
(watch for nasotracheal intubation)
v. https://www.youtube.com/watch?v=-5UVpGjXZcI
(watch for orotracheal intubation)
ENDOTRACHEAL INTUBATION TECHNIQUES

5. BREATHING:
 Breathing difficulties  contribute to morbidity &
mortality in patients with poisoning
 Issues related to breathing include ventilatory failure,
hypoxia & bronchospasm.
VENTILATORY FAILURE:
Causes of VENTILATORY FAILURE:
Paralysis of ventilatory muscles Depression of central respiratory
drive (CNS Depression)
Botulinum toxin Antihistamines
NMBs Barbiturates
Nicotine Clonidine
Organophosphates & carbamates Ethanol
Snakebite Opioids
Tetrodotoxin (found in puffer fish) Phenothiazine antipsychotics
Sedative-hypnotics
TCAs
How to treat ventilatory poisoning?
 Endotracheal intubation

6. HYPOXIA:
Hypoxia is a condition in which the body or a region of the
body is deprived of adequate oxygen supply at the tissue
level
Causes of HYPOXIA:
Inert gases Cardiogenic
pulmonary
edema
Cellular hypoxia Pneumonia/ non-
cardiogenic
pulmonary edema
CO2 Beta-blockers CO Aspiration of gastric
contents
Methane Quinidine CN Aspiration of
hydrocarbons
Nitrogen TCAs Cocaine
Verapamil Opioids
Procainamide Sedative-hypnotics
Smoke inhalation
How to treat hypoxia?
i. Administer supplemental oxygen as required
ii. Intubation (in serious cases)
iii. Treat pneumonia with antibiotics (if evidence of
infection).

7. BRONCHOSPASM:
Defined as a condition in which the lung muscles tighten 
restricts airflow  makes breathing difficult!
Causes of BRONCHOSPASM:
Beta-receptor antagonists Organophosphate poisoning
Chlorine gas Dust particles
Drugs that cause allergic reactions Smoke inhalation
Hydrocarbon aspiration
How to treat bronchospasm?
 Administer supplemental oxygen
 Endotracheal intubation (if serious)
 Discontinue the offending drug or agent causing
bronchospasm
 Remove patient from source of exposure to irritant gas/
dust particulate
 Give beta-2 agonist:
- Beta-2-agonist  relaxes bronchial pathways 
causes bronchodilatation
- Salbutamol (5-15 mg, over 1-hour nebulization)
 For excessive cholinergic stimulation:
- Give anticholinergic (ipratropium bromide, 0.5 mg,
every 4-6 hrs)

8. - Cholinergic overstimulation  increases secretion in
respiratory pathways  causes bronchospasm
- Anticholinergic  reverses cholinergic effect
(hypersecretion in airways)  reduces
bronchospasm.
 For hyperreactive airways  give inhaled/ oral steroids
(anti-inflammatory effect)
 For bronchospasm due to
organophosphate/carbamate/other pesticide poisoning:
i. Give atropine i.v (anticholinergic)
ii. Ipratropium bromide (anticholinergic)  may also
be helpful.