Download Accidents and poisoning

Accidents and poisoning.
Joseph muendo
Facilitator- Dr Njai
• Accident is an unexpected and undesirable
event, especially one resulting in damage or
harm.
• Home accidents account for 38% of all
accidental deaths in children under five, 58%
of accidental deaths occur in or about the
home. If non-fatal accidents are added, the
rate of all accidents occurring in the home
varies from 51.6% at 10 to 14 years of age to
91.3% for children under 1 year of age.
classification
Mainly classified according to cause:
-road traffic accidents
-Drowning
-burns
-poisoning
-foreign bodies in orifices
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Glass related accidents and cuts
Animal/snake bites
Electricity associated injuries.
Explosion
Suffocation and choking
Risk factors for childhood accidents
- Age- from 3/12 to 4 years prone to accidents
at home. More than 4 years –road
accidents/playing outside.
- Sex- male more than female children
- Inadequate/absent adult supervision
- Environment child is exposed to. Rural vs
urban
pathogenesis
• Primary Response: tissue destruction directly
associated with traumatic force; can’t change
amount of initial damage
• Secondary Response: occurs from cell death
caused by a blockage of O2 supply; can assist
to keep minimum damage to other tissues
Injury Response Cycle = pain-spasm-pain cycle
(Chemicals stimulate free n. endings & cause
pain which causes m. spasm & triggers body’s
protective mechanism.)
Three phases of healing
Phase I: Acute Inflammatory Phase
Phase II: Proliferation/Fibroblastic/
Repair/Regeneration Phase
Phase III: Remodeling/ Maturation Phase
Management of childhood injuries.
Based on how the child presents.
Airway-look for any signs of obstruction
Breathing-ensure good bilateral air entry. Also
observe rate and rhythm of breathing.
Circulation-observe pulse-rate rhythm and
volume. Blood pressure important.
(Consciousness also an important parameterindication of severity.)
• Important to look for injury-from bleeding to
fracture sites.
• Contaminated clothing must immediately be
removed to reduce further poisoning
• After stabilization-take a good history-from
person on site or person who found the child.
• Avoid panic especially from parent/caregiver
to establish cause.
• Subsequent management after stabilization
and taking good history will be based on
cause of accident.
Prevention
• Most accidents can be prevented with
increased vigilance amongst parents and
caregivers.
• Environment
This involves safety of the area children are
exposed to. In the house includes
kitchen/store/medicine cabinets-access
should be limited.
children like to imitate adults(learning
mechanism).
• Education
This involves increasing the awareness of the
risk of accidents in a variety of settings and
providing information on ways of reducing
these risks.
this information is not only for parents but
also for caregivers(egs)
• Empowerment
Local consultation and community
involvement can generate a strong sense of
commitment and ownership. Accident
prevention initiatives, which have been
planned by the community, are more likely to
reflect local need and therefore encourage
greater commitment.(crossing roads/gated
communities/provision of playgrounds)
• Law Enforcement
There is legislation which relates to child
safety. These regulations ensure that the
products we buy meet a reasonable level of
safety performance and that new dwellings
meet an acceptable level of safety.
• Child protection act-12. The Children's Act
Act.pdf
• General safety advice
• Children should be supervised at all times
• Keep floors free of toys and obstructions that
can be tripped over
• Always use a securely fitted safety harness in a
pram, pushchair or highchair
• Never leave babies unattended on raised
surfaces
• Do not place baby bouncers on raised surfaces
- they could fall off with the movement of the
baby
• The use of baby-walkers and table-mounted
high chairs is not recommended.
Poisoning
Poisoning occurs when any substance
interferes with normal body functions after it
is swallowed, inhaled, injected, or absorbed.
The branch of medicine that deals with the
detection and treatment of poisons is known
as toxicology.
• “All substances are poisons...the right dose
separates poison from a remedy.”
• Ingestion of a harmful substance is among the
most common causes of injury to children less
than six years of age.
Compounds involved
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Amino salicylic acid
Acetaminophen
Tricyclic antidepressants
Narcotics & drugs of abuse
Benzodiazepines
Iron supplements
Alcohol
Organophosphorus
Important issues in history
• What toxic agent/medications were found
near the patient?
• What medications are in the home?
• What approximate amount of the “toxic”
agent was ingested?
– How much was available before the
ingestion?
– How much remained after the ingestion?
• When did the ingestion occur ?
• a history of substance abuse ?
• Were there any characteristic odors at the
scene of the ingestion?
• Was the patient alert on discovery?
– Has the patient remained alert since the
ingestion?
– How has the patient behaved since the
ingestion?
• Does the patient have a history of substance
General measures:
• Quick assessment & triage
• A…..B…..C…..
• Identify the culprit.
• Limit absorption:
– Vomiting
– Lavage (hydrocarbons/acids/alkaliscontraindicated)
– Activated charcoal instillation
Specific:
ABC’s of Toxicology:
• Airway
• Breathing
• Circulation
• Drugs:
• Resuscitation medications if needed
• Universal antidotes
• Draw blood:
• chemistry, coagulation, blood gases, drug levels
• Decontaminate
• Expose / Examine
• Full vitals / Foley / Monitoring
• Give specific antidotes / treatment
• Decontamination:
1.Ocular:
– Flush eyes with saline
2.Dermal:
– Remove contaminated clothing
– Brush off
– Irrigate skin
3.Gastro-intestinal:
– Activated charcoal:
–May Prevent /delay absorption of some
drugs/toxin.
– Almost always indicated
Only in the 1st hour !!!!
– Naso/oro-gastric Lavage
– Bowel Irrigation:
–Recent ingestions
–Awake alert patient
–500 cc NS Children / 2000cc adults
–Orally / Nasogastric tube
–Contraindications…?
Hydrocarbons-kerosene
-Risk of aspiration
– GIT & Respiratory effects.
– Burning sensation, nausea, belching and
diarrhea
– Cough, chocking, gagging and grunting.
– CXR 2-8 hrs later: Pulmonary infiltrates or
peri-hilar densities.
– Pneumatoceles, pleural effusion or
pneumothorax and bacterial super-infection
– Resolution 2-7 days.
• Treatment:
– Do not induce vomiting !!!!!
– Do not attempt gastric lavage !!!!!!
– Risk of aspiration outweighs any benefit
from removal of substance
– CXR around 2-4 hrs “not before 2hrs”
– Observe in ER for 6-8 hrs if no symptoms 
discharge.
Organophosphorus compounds
• Organophosphorus compounds:
– Insecticides
– Inhibition of Cholinesterase enzymes all over.
• Muscarinic N/V Abdominal pain/ fecal
incontinence
• Cholinergic : cough, resp.secretions, crepitation
and even pulmonary edema
• CVS : Tachycardia/ bradycardia/ block/
hypotension
• Nicotinic: restlessness, confusion,
coma,flaccidity/convulsion
Diagnosis: blood Cholinesterase levels
< 50% indicates poisoning.
Atropine as test dose
Management:
A….B….C….. Stabilization
Wash hair and body with soap & water
Consider Gastric lavage if within 1hr
Atropine sulphate I.V. till pupils are normal size.
Dose = 0.02 mg/kg Q 15-20 mins
Atropine sulphate I.V. till pupils are normal size.
Remember…Atropine has no effect on muscle
paralysis  must support breathing
USE
Cholinestrase reactivator such as Pralidoxime
Dose = 1gm /kg IV Q 30 mins
Carbon monoxide poisoning
• CO is a colorless and odorless gas that is
created when burning a fuel, such as gasoline,
propane, natural gas, oil, wood and charcoal.
• improperly ventilated stoves and fireplaces, as
well as running cars, can lead to a build up of
CO gas in enclosed or semi-enclosed spaces.
• Because of their high metabolic rates and high
tissue oxygen demands, children are biologically
at increased risk of CO poisoning when exposed
to CO.
• Common symptoms include headache, dizziness,
fatigue, nausea, vomiting and confusion.
• May lead to coma and death.
• CO poisoning can often be mistaken for flu or
food poisoning. If CO leak, more than one person
may have symptoms.
management
• Attention to the ABCDs of resuscitation is the
mainstay of emergency care for the patient
with CO intoxication.
• All patients with suspected or confirmed CO
exposure should be given 100% oxygen until
they are asymptomatic and the
carboxyhemoglobin (COHb) concentration is
below 10%.
Poisoning prevention
• poisoning prevention.docx