EVALUATION OF THE ENVENOMED PATIENT Assessment of type and extent of envenoming Neurotoxic paralysis ' Sleepy' or drooping eyelids Difficulty swallowing, dysarthria and drooling Limb weakness Respiratory distress. Excitatory neurotoxicity Sweating, salivation, piloerection
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EVALUATION OF THE ENVENOMED PATIENTAssessment of type and extent of envenoming Neurotoxic paralysis'Sleepy' or drooping eyelidsDifficulty swallowing, dysarthria and droolingLimb weaknessRespiratory distress
Taking a history in envenoming
Important substances involved in poisoning Analgesics, e.g. paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs)
In South and South-east Asia
Poisoning in old age
GENERAL APPROACH TO THE POISONED PATIENT
Triage and resuscitation
s Patients who are seriously poisoned must be identified early so that appropriate management is not delayed. Triage involves:
Those with possible external contamination with chemical or environmental toxins should undergo appropriate decontamination .Critically ill patients must be resuscitated
Substances of very low toxicity
Causes of acidosis in the poisoned patient
The administration of activated charcoal may be considered if a patient has ingested a potentially toxic amount of a poison (which is known to be adsorbed to charcoal) up to 1 hr previously.
Multiple-dose activated charcoal
1.'Multiple-dose activated charcoal should be considered only if a patient has ingested a life-threatening amount of carbamazepine, dapsone, phenobarbital, quinine or theophylline
.'2.Gastric lavage 'Gastric lavage should not be employed routinely, if ever, in the management of poisoned patients.
'3.Whole bowel irrigation (WBI)