me _ 182 wv Guuerssod ur dw ayn OQ acre) ge poll, O -suaisiadd 92° ssoulicy O asst 90 votre i sso O espuoniudsy mS rap wt pp vaipoqeor) 0 Py‘Suicidal poisons: Barbiturates, HCN, Corrosives (oxalic acid, carbolic acid ) ‘© Homicidal poisons: Aconite, Arsenic, mercury and antimony - ‘= “Accidental poisons: Kerosene oll, insecticides, snake venom, household drugs a elds — oval acids, carbolic acid, acetic acid, seit, HON Nonmetalic~(G) 81, Boron, Phosphorous) Organicirritants : “Vegetable poisons (castor oll,ergot,matiai,abrus prectorious) ‘Animal poison — (snake venom,insects bite (scorpions) Mechanical poisons ~(powder glass, died sponges, es———} a D at i bo ) , i) Small dose (less toxic) fi) Large dose (more toxic) i) fdlesyncray (Inherent intolerance towards certain drug) eause intense symptoms. iy) Allergy AP fat creased dose aes tx as compared normal eu vi) Synergism (Alcohol +barbiturate) vii) Emesis caused by certain poisons (there will be decreased toxicity) i) Physical state (gases>liquid>solid) ii) Chemical combination (ifald with alkalis, strychnine with tannic acid) Ail). Mechat bination (alkaloid with activated antmal charcoal) decreased toxllty {inhalation>IV>IM,SC>ingested>topical) §) Snake venom Poisons IV Harmless orally ii) Cocaine ‘Anesthetic 1V Derelent, convulsant orally 1) Age (greater effect at two extremes of age ii) State of health {if} Sleep and intoxication (action of polson Is delayed) galaxy1, Acute 1). Symptoms suddenly appears A) The person previously to be good health ff eS lil) Symptoms do not confirm to ordinary illness st al 4v) Symptoms severely increases ‘v) Poison can be detected oo 2. chronic i) Symptoms develop gradually see 19 Pa ae complete lsappearance ofsymptoms iil) Poison can be detected in fo \s) Malaise and repeated attache of undiagnosed GIT irritation | —__ | Bikestosenrnean. 1. Postmortem examination 2 Chernical analysis 3. Experiments an suitable animals (to detect poison in food) ~~] Moral and circumstantial evidence (suicide note, s hitiy tgirls * Pesos det nity ies by Ga aa, oe - eee nse ‘These samples align saeie pe lereerie see rais Sep hap hos eu to ~ domestic.animals suchas dog.and, cat + 0 on oar = thing was a — polson or not. . Trea eet iy tiie 90 recent purchase of poison by the vie or cused, his behaviour, . Seeger ‘victim may also provide some information ‘aind helps inIf poison is unknown, the following steps are followed bylmanagement. | 7 1. Removal of unabsorbed poison, depending on rate of entry -———— i) Inhaled: Patient should be moved to fresh air, postural drainage. 2 ii) Injected: Forniquet proximal to injection oe i. fii) Contact: Wash it out with plaln warm water with antidote. a ; iv) Induce vomiting, stomach was! __ 2 Use: an {) Ifpolson not completely removed by gastric lavage, emesis ii) absorbed —_——— ili) Administered through parental route ——_— z 3, Elimination of absorbed poison: aT 1) Accelerate its execration aaa {i) Peritoneal analysis ic | lif) Exchange transfusion - ae ee ee Iv) Whole bow! irrigation } 4. Treatment of general symptoms: ————— 1) Morphine for pain + li) Artificial respiration for failure i __ at {i3) Cardiac stimulant for shock — - | amet) Diszepam for conctusion _ Maintenance of general patient condition: | Patient must keep warm comfortable _ {i} Use of antibiotics tn case of infections iii) In attempted suicide, Psychotherapy should be performed — GD) EROS ance are remedies which counteract or neutralize the effects of poisons without | causing appreciable harm to the body. 7 aeenion: Gs y —— ———1. Mechanical or phstalantdets np the absorption of poison by their presence. 1) Demut z ‘ 1i)_Activated chat ? —_— la, ch ‘antidote: through chemical action or oxidizing the poison to un activate. f) Dilute acetic acid to neutralize alkalis , _ if) Dilute alkali mitk of magnesia (to neutralize acids) _ lif) Potassium permanganate. CK#%n2a) lor bar bikurade &-exyen cle poisioring - ————3. Physiology or pharmacological: Produce effects which Is opposite to that of poisons. es 1) Atropine for pilocarpine Ww) Redlgleptcin for acekam inoghen - Mf) Diazepam for strychnine vy Atropiné toy ovganoy : — | iif) Naloxone for morphine is. Produce non-ionized cyctic complexes(chetate) with caution, heavy a ere are non-toxic stable complexes. __ Examples are BAL, EDTA, Penicillamine, Versanate, desferrioxamine® 5 British anti-lewisite), also.called = [> dame I, also.called dimercaprol fs used jn the treatment of certain —— types of heavy metal poisoning. itis contraindicated in iver damage. = mee \EDTA effective i lead, mercury, arsenic and copper poisoning. tis superior to BAL In ees le _—__—_| the treatment of arsenic and mercury poisoning. Itis contraindicated in renal damage. ‘a degradation product of penicillin. tt can be given orally and is less toxic |. than EDTA. It is the drug of choice in copper, lead rcury poisoning. —_—_—. Itis used in the'tre 6f acute iron poisoning ——4s Universal Antidote: used when nature of ingested poison ls unknown. a = Example are powered charcoal 2 parts+ milk of magnesia 1 part rtannic acid 1 part ___ galaxy_——‘Stomach washing withla about 46 hours after ingestion of poiso™ 199 Procedure: % it hips upward. ‘Semi prone position with head down. hips > Abeway mi +r and introduction of mouth fae . 3 Taree ea pe’ tube forehldren length 2Scm) after lubricatio! ‘ through liquid parafine over tongue backward and downward dough esophae= _- : a ibe hear + When tube reached the stomach, confirm it by blowing little air down the tul _ bubbling sound through stethoscope (In trachea hissing sound is heard. 5. About quarter liter of plain warm water Is run Into funnel. we §. Then lower the tube ae level of patient to allow the gastric content came out through siphon out. eee 7. 1s washing should be pressured. 8. Onward washing is done through antidote solution, 9. Before stomach tube is withdrawn ft should be pinched to avold aspiration. 10. In children Ryle's tube is used, ao 11. SOml glass syringe is used. _ | CONTRAINDICATION: a, 2. Strong corrosives 2 Unconscious ne 3. Inconvulsions - 4 Kerosene oil 3 5. Hypothermia INDICATIONS: ‘COMPLICATIONS: 1. Infection of unsterilized tube is used. C 2. Injuries of tube is not lubricated. 3 Chocking i body ts pushed downward. 4 Aspiration pneumonia, i... 5. Hypothermia 6 Electrolyte imbalance by repeated excessive wash © Dacis of RMP income of Prong | ay sed prolaninsy partes : 1) Fullname } Wi) Age til) Sex | iv) Occupation | Wy Address vi) Date and time vil) Brought by whom wii) History ix) Dying deceleration if needed. - 2, 1seduty to treat the patient. 3. Doctorin| private nic willnot inform police in case of suicide or accidental poisoning unless |§ ————— summoned. 4. Notify public health authorities in case of mass accidental poisoning, ~ 5. Inform police in homicidal poisoning. 6 Must keep the record, 7, Must prepare each and every sample in separate container and proper iabel it 8 Dying declaration Ifthe person is serious. 9. In ee of death, death certificate should not be issued but fact of police must be ‘communicated ~~ to police. A 411. Doctor in pubic or government hospital must be report to police in all cases eT .——= 41 : SALICVLATE POISONING LETHARGY/ \_ EXCITABILITY : "Severe. Tox citys METABOLIC ACIDOSIS) 7 ie avi = CHILD = 12 ADULT ASPIRIN 2 bicavioonate ‘OR 4B BABY ASPIRIN i i. + Seelium . Poisoning result: from overdose or idiosyncrasy. symptoms include: Giddiness, buzzing fh ear, edema of face, eyelids skin rashes, cyanosis, flushed skin and Aspirin irritant mucota of Gastrointestinal Tract cause vomiting, hematemesis, mclona” Hemorthage due to hypoprothrombinemia srapnea : Hoperventiaton v Acid base disturbances * Retosisand severe acidosis! (/NLipid coat) = i ;a - Ttis protoplasmic poison and prevent tissues from utilizing oxygen of blood by inhabiting ——— oytochrome oxidase enzymes and death occur die ta cytotoxic anoxia (cellularasphyxia}. §—§ —— So milliaawn (15-20 bitter almonds)» 1-20 min-_ = + Biter “Almond melt rom body - + Face i» psec - _ . Papit—alal _ bl 2 Pelechial hoseEXTERNALLY: ie 1. Dehydrated 2. Cyanosed appearance 3. Sunken eyes 4, Wrinkled and jaundice skin 5. Rigor mortis last longer than causal _ ———— INTERNALLY: \% Red velvet stomach | el el ee PS Se 2. Mucosain red swollen SS 3. Ulceration and ervsion present at pyloric end. 4. Petechial Haemorrhage under endocardium jt 5. Haemorrhage may be found in abdominal organs, lungs | 6 Fatty degenerative changes inliver, kidney and heart, <=—— | ~ Psenic Poisoning 0 “Asay Pain in Hine cotelg_ + Momiti befor cltavhea - so so Hoog\- ad arsenic particle ‘opiate nt© Commenced jr 2 9s & ‘ . o - z Mucous membranes are inflamed f ie running of — é ~ the eyes and nose, coughing and bronchial Arsenic ere PI po i galaxy.‘Todestroy viston ‘Cause facial disfigurement ‘Sulphuric acid 's commonly used Disecloratian of skin and eloths are common findings nq ‘Tlekle marks, absence of vesleation and pressure af cltemats In the stan weep ——————— CO 1 a a Gaevle peters) . Fra “Throwing any corrosive ona person with malleous Intent > ‘Treatment consist of | Immediate washing with water and soap, or diluted Sodiineartonate solution applled plication External Bc, —— | Corrosion of part that comes in contact ASS ; Z._ Especially lips, mouth, angle of mouth = 7h Toph Andeloths i, Jaminophin (aya Internal: 41. Pharynx and esophagus + Inflammation, edema, bleeding, 2 Stomach ~ convert into soft bendy black which disintegrate to 3. Surrounding viruses stinging and perforation in stomach want 4. Larynx and trachea - corrosion, inflammation. > t 4 ' t ‘The symptoms are described & 1. Gastrointestinal |__| 1). Vomiting: ii) Patients fly non conscious —___| 2 Latent stage: me {) After 4 hours § | it) Liver damage Ss ii) Pain free | |) Anorexia, epigastric palo, malaise —_——— 3. Hepatic allure: 1) After4—S days —= = 1X) Gastrointestinal Hemorrhage SSS} il) Cardiomyopathy — = —_—} 1. Hospitalization 2, Gastric lavage within 4 hours 3. Rehydration for protective vomiting but not m i ‘4. Hypertonic dextrose, bicarbonate: tes me than 25 Iters/day 5. Vitamin kand whole blood plasma infusion 6, Hemodialysis in case of renal failure 7. Oral methionine log on 12hours over 4 doses or IV cystat 8. Incerebral cream hypertonie glucose, IV infusion nt? thin 10 hours,Hyaluronidase- Sa ns 1+ Neurotoxicinctapids (neuro > eyes) 2 Vasculotaxic in vipers (V> — 3. Myotoxic in sea snakes (Myo > sea food protein rich) = Bo ns. 7 - = i) TSmgof cobra + il) 40mg of viper _ il) 6mg of krait = © 1) In Cobra few hours — ii) In viper - few days il) Sea snake~ not fatal — Fig. 38.162: Potzonous enakes: Russo's viper (noto—ranguar head with distinct V7, narrow neck and stout body with three cows ot iamond shaped chain Fig. 99.18: Poisonous snakes: Sanded krait Main sign and f) Burning atthe sites ii) Teeth marleand oozing muscular wea is, paralysis of leg muscles, dimness of Elaplds: Giddiness, lethargy, muscular weakness, ptosis, pa . Halon, cyanosis, convallons, dysphagia ‘Vipers: Nausea, vomiting, hemolysis, hemorrhage dilation of pupils, neurosis of renal tubules, shock, ‘Sea snake: Sharp inital prick and then it becomes painless, Generalize muscular paln, Myoglabinuria, hyperkalemia.B i nen rut Give 24-30 ml Polyvalent antivenom « Inject” we otnyl £: neostigeine. pce Mimiltersterldsandanalgesis’- "4p gt Tosi =a -Adminiter : * Injeck & Horimsene soa . . ae * pu Chotinesstmxe Inhibitor ——» tf Ash in, Byperer citation __Syeete “ae ——— Pavathion ; 1% mg. Melathion . jon, _L-gcane 4-3 hrs: Bante) _ = Mrinalion —> (Frequent Uningtron) eS Conon ot Vision) ___ Be Br 6B: em Astana) E 2 ee eS oa Sell oe bax ora On > Chromonenic. CRel) teas. g Seadiy ation’2 Grae tue cine he ret a sc eed “3. Airway should be maintained aie 4.” Attificia respiration is giveny If necessary. ——__| soni ii 1. ‘Atropine: Atropine isthe first drug to be given in organophosphorls poisoning. Inject ———— ‘atropine 2 ng Lv. stat and it Should be repeated every 5-10 minute doubling the dose, if | ue pate ron oy ead este pus, hushed should be continued for 7-10 ays: skin, tachycardia etc) Atropine aaa 2 ee eS . Burning pain in throat, esophagus, stomach, intense thirst, _| _ PHHOSSYIAW: Garlic taste in mouth and breath | 1+. Due to chronic poisoning of phosphorus (gas fumes inhalation) Jauminous vomit -{ 2 Thegas attack jaws (lower) and eause the following symptoms. Dark offence stools 3. Tooth ache followed by swelling of jaw. S Hematuria | A Loosing ofteth necrosis of jor Canmore proseebieg & Sequestration of wandhle tone : i re i wv, 6. Multiple sinuses form in bone which discharge foul swelling pus. jaundice, hemar a tg a1. Elemental 2, Inorganic salts 3, Organic salts Signs and symptoms Corrosive action of GIT, nausea, vomiting, burning, neurosis, renal failure, shock, pulmonary edema, comma, muscles tremors. . | Abdominal symptom, nausea, colle pain, vomiting, brownish blue line in gums at functioning “ —____| rer urcura lentis in anterior capsule of lens (Thickening of skin) ‘2. Marcural tremors - haters shake (Absent in sleep) 3. Breathism ~mental symptoms (Weak memory, hallucination and insanity) ‘Treatment: Gastric lavage, milk, egg white, activated charcoal, BAL, penicillamine, hemodialysis, extra corporal regional complexing hemodialysis. rs eseness, tremors, paralysis, loss of vision, hallucination, insanity prlyhroresia may coun), peas basen reser == Coloured plitiead ke spots in the cytoplasm of [RBCS in blood), poltdlocytosis (ine-poikilocytes), Increased mononuclear cells and | m teadting : = + Bluish-back ine seen on gums due to sub-epithelia deposition of lead ; : eerie: oom Dal ae aima Tee : © Colic (pain in abdomen and bowels)! ft 'Fetieved by presstire on abdomen. * Constipation also accompanies‘cotiepatnss*:4 °°Optic atrophy ray alo occ. “Renovscular Manifestations ‘Vascular constriction ss Heads to ven en | _— taste burning pain, nausea, De stained vomiting, muscle cramps, vomitus must | bbe differentiate from bile or billow vomit - 1! 2 there fs metallic taste, ms, GIT disorders, anemia, | laise, peripheral neuritis, wrist drop, foot dro} | ubwaase somal EH 72 hours Tg 384: eae ta ep spat : galaxy8. € 1. Stage of excitement (blood alcohol 30- 100mg%) i) Feeling weltand pleasure 4 1) Behave in obscene manner “@ ii) tmpaired complex skis {v) Increase sexual desire 2 Stage of incoordination (100 =300%) 1) Incoordination in talking taught, actions, impaired judgement 15) tecups Ai) Nausea vomiting, {v) Dilated pupils ¥)_ Sexual excesses, violence crime 3. Stage of marcasis (300mg% above) |) Deep sleep response only to strong stimuli 1) Rapid pulse, subnormal temperature 1s) Increase respiration W) Death dueto paralysis and cardiae depression. ry ee gg ee Pe SER ETT PITTom ___209 Ft Mon te Wes ood oo a _ ———— —_— = Jog {2 Without his consent __ 3 Recording bio data, time. date — ————— — & Giinical examination oe _ S. Smelt of alcoholic beverages in breat «SCC Loss of self-control and disordered clothing, __ 7. Sluggish dilated pupils and check for fine lateral nystagmus — ~~ B Certain phrase test for speech, slurred and incoherent speech 7 9. Finger nose test and walkin straight line (ar coordination. — ~~). 10 Reflexes test relexes will be delayed. _ 12 Impaired memory of recent events —__ Samples of chemical analysis: 1. Blood = ——— 2 Urine 2 Breath Siena Wrosceen ee Se i met to mem ‘Treatment volves LV vitamin B administra ‘Agate Hallacioodls ipium Coma occur due to morphine Poser eS SSeaCTe 1. Patient passes to deop coma from which he. ‘cannot bea 2 Muscts are relaced and reflxesareoosed oe 3. z 9%1. Stomach wash with potassium permanganate 2, Maintain body warmth 3. Naloxone 0.4 ~0.8mg IV 4. Glucose infusion 1V S. Oxygen and artificial respiration & Stimulants such as adrenaline 7__Strychnine is given If necessary 00 -125 mag - i a with hye, abdomen Bi dryness of mouth, dysphagia and burning pain in Skin rashes, ded pups boty skin vomking Pyrexia, diplopla a i. Giddiness staggering, delirium — 5. Visual hallucinations ae Tendency to grasp imaginary objects ee = —__ Atropintzation: ——_~ — Sympathetic activity due to blocking of parasympathetic system by atropine. These signs are Flushed face, dry mouth, dilated pupils, fast pulse and warm skin. cient ee x a ning, atropine is administered in a dose of 2mg every 35 to Somer clearer! setae recan nme 30:minutes til the signs of atropinisation apper : = Tealmed | 7 | Management of datura poisoning: ey 1.” Stomach wash with $96 tannic acid 2 Neostigmine2SmgiV every 4 hours. Asan antidote 3. Physostigmine 1.4mg repeated at 1 - 2 hours ifnecessary 4 Lipid sponging for raised temperature SS {+ Diazepam 1omg IV for convulsions 6 War ener a5 prative _ pu 1. Euphoria . negthtloss. weanes, tremors _ 2. Dysphagia ; jomania in female, homosexuality in mal 3, Dry mouth 5 Sasa ath licination, Magnan’s symptoms) ——— 4, Tingling and numbness A Serwuil dere in 5. Dilated pupils ‘Fomale “/Magnan’s Sign: (Tactile Hallcernationy, (Mae ‘Magnar’ssgnisa cna signa which peope wth eocsne ston chrnictacae 7 poisoning) experience paraesthesia which feels like a constantly moving foreign body, ————— _ ‘such as fine sand, powder or bugs, under the skin, Wechogibtine in _ “The sign is named after Valentin Magnan:~~ 1. Produce physteal and psychological dependence. esse - > ical epee and pst increase sexial act duration, — | 3: Prostitutes inject cocaine into vagina - — 4 Als due to unsterile injection = 15 Body ec aay cur due to breaking packages which contain cocaine. _ — $ Rapid puise a ~ & Myperthermia “Tk at increase — 9. ‘Tonle dose-in coordination, muscular twitches, convulsions + 10. Stage of depression, decrease respiration, collapse - Teast manade. CEMnOw) RE cele — poknon_pama . eV — “Tourn went—— Its active principle is tetrahydocannabinol (THC) and is absorbed both from digestive and respiratory tracts. Its stimulant ofthe central nervous system and {s used in the following four — forms: 1. Bhang: is prepared from the dried leaves and fruit shoots. It contains the active principles in a — concentration of 15% and is least potent _ 2 Malun: This is a sweetmeat made with bhang. It produces delusions in addition to all effects of bhany ‘Gana consis ofthe owering tops ofthe female plant: It contains the active principle ina concentration of 25% 4. Chars: Itis the resinous exudate from the leaves and stems of the plant. It contains the active Principle in a concentration between 25 ~ 40% and is used for its supposed aphrodisiac, hypnotics and analgesics effects 5 HH in small dese > euphoria at first followed by nareosis 2. Visual hallucination 3. Person has afecling of cheerfulness and tends to become talkative 4. The victim may pass into deep sleep for 6 hours 5. Drowsiness > Coma > Collapse > Death ars 2.0gms, Ganja 8.0gms, bhang 10gms per kilogram of body weigh : ight Sstric Lavage with warm water, bypodermic injection of strychnine, strong tea or coffee, ration and saline purgatives may be helpful |) Accidental Poisoning = ii) Aphrodisiac Purpose This is a condition resulting —_— __tl) Used as stupefying agentCrreatiment | Stomach wash with warm water Hypodermic injection of strychnine Strong tea or coffee by mouth or per rectum Artifical respiration, IV flald Saline purgative. *Tranquilizers and general management —— | — ] ee Me FI9.34.18A 0c: Sremarens ux vomiea ¢Strychnine) plant (a) Pars tan a ey) rae gel tase fe ‘Sign and symptoms + Twitching of museles of face —— —= Risus sardonicus a Convulsions ‘Opisthotonos ae Cyanosis Dilated pupils Ferthy salivation Epigastric pain Mind remain clear, death is painful PPO MEM NE* _ftoccurs due to strychnine: Sy Sp AG oe pian sandonicuisa ht character abner, sual SPS muscles that appears to produce erining (broad smile, evi ike}. 1. Patient should be kept inn darkand quite room to avoid excitation ‘Quick anesthesia with chloroform Intravenous diazepam 2 Stomach wash with potassium permanganate Suspension of activated animal chareoal tarmxamic acid —— Barbiturates as antidote Mephesenin IV 3mg/tg, — Turbocurarine ® eR Pe eN 9, Oxygen and artificial respiration ——————we a Sellen —$—_§ ‘Signs and symptoms of Carbon monoxide polsoning, a as 1. Dizatness, throbbing headache — et ee 3. Muscular weakness — Mental confusion incarnation, convulsions, oma S. Cherry red discoloration of mucus membranes Se ache there 7 Dilated pupils = — aes ee Fine ra mye seen atti net andthe noe ** The colour of the'skin, especially in areas of postmarteit stain. a BBersons, is bright cherry red if saturation of CO in blood exceeds sbout'30%! ay ———=}' ‘tin blisters can be seen in the areas of skin apposition and in contact with the ground. ——| ; Blood, tues and viscera ae ofa a (COHb/100 ml of blood. — |< = _serus ein Samba" 7 eh ——- * iain may be edematous an petechial hemorthageis seen nthe inéninges, - Se Necrosis and eatin of glabra, putamen may be fund in eases of proisages hypoxia. * Lungs may be edematous galaxy.