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Drug ODPoisoning Transfusion
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Can be done up to 4 hours after ingestion. Not effective for alcohol ... Endoscopy/surgery may be needed for iron overdose or to remove body packages (eg ... – PowerPoint PPT presentation
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Title: Drug ODPoisoning Transfusion
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Drug OD/PoisoningTransfusion
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Management of OD/Poisoning
- Resuscitation/supportive care
- Protect the airway/respiratory support
- Fluid resuscitation
- Maintain acid-base balance
- Substance ID
- What drug was taken, how much, by what route
- Past history
- Current circumstances
- Associated trauma
3
Management of OD/Poisoning
- Investigations
- Drug ID by blood, urine, or gastric aspirates
- Alcohol level
- CXR (pulm edema with salicylate OD)
- EKG (ischemia with cocaine)
- Prevention of absorption
- Gastric lavage
- Can be done up to 4 hours after ingestion
- Not effective for alcohol
- Harmful after ingestion of caustic products or
petroleums - Patient is in left lateral position
- Ewald tube is used as it has a larger diameter
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Management
- Activated charcoal
- Absorbs drugs and promotes elimination
- Given after gastric lavage and at 4 hour
intervals - Wont bind iron, lithium, alcohols, acids,
alkalis, cyanide, or organophosphates
(pesticides) - Causes constipation
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Management
- Addition measures
- Induced vomiting with ipecac is not often doneit
risks aspiration - Cathartics promote diarrhea and reduce drug
absorption, but risk fluid/electrolyte loss - Skin decontamination is essential for toxins
absorbed through the skin, like pesticides - Endoscopy/surgery may be needed for iron overdose
or to remove body packages (eg-illicit drugs that
have been packaged and swallowed)
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Management
- Enhanced elimination
- Gut dialysis
- Uses repeated doses of activated charcoal to bind
drugs - Forced diuresis
- Increases urine production with IV fluids
- Risk of fluid overload
- Hemodialysis
- Removes low molecular weight, water soluble
molecules - Hemoperfusion
- Useful to remove lipid-soluble drugs
- uses charcoal or resin columns
- May cause hypocalcemia and coagulopathy
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Specific Management
- Paracetamol (Tylenol)
- Depletes hepatic glutathione stores, causing
accumulation of a hydroxylamine metabolite that
causes liver and renal damage - Treat with N-acetylcysteine (Mucomyst)it
increases glutathione levels and reduces toxicity - Can also be treated with methionine
- Tricyclic antidepressants
- Cause most OD fatalities
- Toxicity is due to anticholinergic effects
fixed pupils, dry red skin, hyperthermia,
tachycardia, urine retention, CNS (psychosis,
seizures, hallucinations) - No specific antidote but gastric lavage and
activated charcoal can reduce toxicity - May cause potentially life-threatening
arrhythmias and hypotension
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Blood and Blood Components
- Whole blood is collected into citrate/phosphate/de
xtrose/adenine anticoagulantone unit is 430 ml - It has a longer shelf life if its divided into
its constituent parts by centrifuge - Red cells are then packaged in saline, adenine,
glucose and mannitol and have a shelf life of 42
days - Platelets last about 7 days
- Fresh frozen plasma contains all the clotting
factors but it takes about 4 units to see
clinical resultscan store up to a year, though - Fresh whole blood has all the clotting factors,
etc but reactions are common - Stored blood is still metabolically active pH,
2,3 DPG, ATP, platelets, and clotting factors all
decrease while potassium increases (from cell
rupture)
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Coagulation Tests
- Prothrombin Time (PT)
- Tests the extrinsic pathway
- Clot formation should occur within 12-14 sec
- Increased PT caused by
- Liver dx
- DIC
- Warfarin use
- Vitamin K deficiency
- Salicylate poisoning
- Circulating anticoagulants
- Excessive heparin
- Activated Partial Thromboplastin Time (APPT)
- Tests the intrinsic pathway
- Coagulation should occur within 40 sec
- Increased APPT caused by
- Hemophilia
- Heparin use
- Von Willebrands dx
- Inadequate specimen
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Coagulation Tests
- Platelet count
- Bleeding time
- Tests platelet function
- Should stop bleeding within 9 minutes
- Activated clotting time
- Factor assays
- Can test for specific factors, such as fibrinogen
- Or can test for products of factor degradation
- Fibrinogen degradation products
- D-dimers
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Bleeding Disorders
- Genetic coagulopathies
- Hemophilia A factor VIII deficiency
- Hemophilia B factor IX deficiency
- Von Willebrands
- Autosomal dominant trait
- The most common hereditary coagulation dx
- Decreases factor VIII activity and reduces
platelet adherence - Liver disease
- Causes vitamin K dependent coagulation factor
deficiencies - Can also get vit K deficiency with malnutrition
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Bleeding Disorders
- Anticoagulants
- Oral anticoagulants cause vit K dependent
clotting factor deficiencies - Heparin potentiates antithrombin III which blocks
the action of thrombin preventing clotting - Antiplatelet agents (like ASA) inhibit platelet
function for up to 10 days - Circulating anticoagulants increase with some
drugs (eg-Penicillin) and diseases (AIDS/lupus)
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Bleeding Disorders
- Disseminated intravascular coagulation (DIC)
- Follows widespread clotting
- Bleeding is the most common symptom
- Causes
- Spesis
- Surgery
- Liver failure
- Malignancy
- Incompatible transfusions
- Shock
- Poisoning (snake venom)
- Autoimmune dx
- Pregnancy-related (eclampsia, sepsis)
- Thrombocytopenia
- Decreased platelets
- Could be decreased production, increased use, or
loss of platelets
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Transfusion
- A full cross-match takes about 45 minutes
- Blood type determination takes 10 min
- O negative blood is given when blood is needed
immediately, but may cause some
reactionuniversal donor - Type specific blood is preferred if time is
available - After 5 units of blood, clotting disorders and
other problems may developblood filters
recommended for large transfusions
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Transfusion
- Risks of transfusions
- Acute hemolytic reactions
- Incompatible blood group
- half due to administration error
- Urticaria, rigors, shock, asthma
- Non-hemolytic reactions
- Reaction to donor WBCs
- Fever, chills, urticaria
- Acute lung injury
- Delayed immune reactions
- Massive transfusions can cause
- Coagulopathy (eg-DIC)
- Hypothermia
- Volume overload
- ARDS
- Infection
- Biochemical abnormalities (increased K, decreased
Ca)
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