Changes

==Clinical approach to a suspected poisoning case==

==Clinical approach to a suspected poisoning case==

It is probably a little unrealistic to be abel to diagnose a poisoning case on initial examination. Bear in mind malicious poisonings in particular are extremely rare but frequently suspected by owners! Symptomatic therapy is usually the way forward, as so few poisons have a specific antidote (rat bait poisoning and adder bites being a noticeable exception). A general approach to a suspected poisoning case shold include:

It is probably a little unrealistic to be able to diagnose a poisoning case on initial examination. Bear in mind malicious poisonings in particular are extremely rare but frequently suspected by owners! Symptomatic therapy is usually the way forward, as so few poisons have a specific antidote (rat bait poisoning and adder bites being a noticeable exception). A general approach to a suspected poisoning case should include:

*Prevent further access to the poison

*Prevent further access to the poison

*Reduce further absorption - depending on the route of absorption -  

*Reduce further absorption - depending on the route of absorption -  

**wash skin thoroughly with water

**wash skin thoroughly with water

**Induce emesis if ingested but '''NEVER''' do this if the substance is corrosive or the patient non responsive

**Induce emesis if ingested but '''NEVER''' do this if the substance is corrosive or the patient non responsive

**Gastric lavage can be perfomred if the patient is unconscious, '''after placing an ET tube with the cuff inflated'''

**Gastric lavage can be performed if the patient is unconscious, '''after placing an ET tube with the cuff inflated'''

**Use purges to speed gastric transit time such as Sodium Sulphate 1gm/Kg

**Use purges to speed gastric transit time such as Sodium Sulphate 1gm/Kg

**Add frusemide to speed renal excretion if indicated

**Add frusemide to speed renal excretion if indicated

*Provide supportive care to -

*Provide supportive care to -

**maintain body temperature using controled indirect heat sources such as heated mats or 'hot hands'  

**maintain body temperature using controlled indirect heat sources such as heated mats or 'hot hands'  

**maintain cardiovascular function using fluids, drugs and monitoring haematological values periodically

**maintain cardiovascular function using fluids, drugs and monitoring haematological values periodically

**maintain respiratory function using oxygen cages and drugs if necessary

**maintain respiratory function using oxygen cages and drugs if necessary

**monitor and correct acid base balance abnormalities

**monitor and correct acid base balance abnormalities

**monitor CNS signs and treat using drugs (for example Diazepam) if required

**monitor CNS signs and treat using drugs (for example Diazepam) if required

**reduce pain - use causiosly drugs that have profound effects on cardiovascular and respiratory function such as opiods if these sytems are showing compromise already  

**reduce pain - use cautiously drugs that have profound effects on cardiovascular and respiratory function such as opiods if these systems are showing compromise already  

*Provide a specific antidote where the poison is certai and a known antidote available (adder bites, rat bait ingestion)

*Provide a specific antidote where the poison is certain and a known antidote available (adder bites, rat bait ingestion)

==Sudden death cases==

==Sudden death cases==