Emergency Management for Poisoning

1. Stabilize the child. Assess ABCs (airway, breathing, and circulation). Provide ventilatory and oxygen support. 2. Perform a rapid physical examination, start an IV infusion, draw blood for toxicology screen, and apply a cardiac monitor. 3. Obtain a history of the ingestion, including substance ingested, where child was found, by whom, position, when, how long unsupervised, history of depression or suicide, allergies, and any other medical problems. 4. Reverse or eliminate the toxic substance using the appropriate method: a. and agonists Mucomyst (for acetaminophen poisoning) Narcan (for overdose) Romaxicon (for benzodiazepine overdose) b. Gastric lavage ➤ A gastric tube is inserted through the mouth. ➤ Normal saline solution is instilled and aspirated until the return is clear. Considered a less effective method of removing ingested substances from the stomach than . Reserved for children with central nervous system depression, diminished or absent gag reflex, or unwillingness to cooperate with other measures. ➤ Contraindicated in children who have ingested alkaline corrosive substances, as insertion of the tube may cause esophageal perforation. Used in children who have ingested acids to decrease continued damage and potential perforation of stomach and intestines. Activated charcoal ➤ Given to absorb and remove any remaining particles of toxic substances. ➤ Usual dosage administration is 1 g/kg of body weight. ➤ A commercial preparation of activated charcoal is administered orally or through a gastric tube. ➤ Available as a ready-to-drink solution in an opaque container. ➤ May be mixed with apple juice or soda if protocol allows to encourage consumption. ➤ A covered cup and straw is used for oral ingestion to prevent the child from seeing the black liquid and to minimize spillage. ➤ Activated charcoal is administered only after the child has stopped vomiting, because aspiration of charcoal is damaging to lung tissue. ➤ Should not be administered for ingestion of caustic substances or hydrocarbons. c. Cathartics ➤ Hasten excretion of a toxic substance and minimize absorption. The most commonly used cathartic is magnesium sulfate. Note: Syrup of ipecac The use of ipecac is no longer recommended because it may not remove all and can be harmful in some situations. Encourage parents to remove it from their homes. 5. Other measures will depend on the child’s condition, the nature of the ingested substance, and the time since ingestion. May include diuresis, fluid loading, cooling or warming measures, anticonvulsive measures, antiarrhythmic therapy, hemodialysis, or exchange transfusions. 6. The child’s total condition is constantly evaluated to maintain airway, breathing, and circulation. Therapeutic management is adjusted as needed to treat evolving condition. 7. Consider the emotional status of the family. Provide information about the child, involve the child in care when possible, and arrange for support persons and services to be available to the child.