1. To establish rapport among people 1 min Introduction about self : Myself Tejinder pal kaur,student of MSc nursing-1st year in SGL College of nursing ,Jalandhar

Teacher gives self introductio n





To assess the previous knowledge

2 min

Question: Q:1 Define poisoning? Q:2 what is poison ? Q:3. Enlist the common poisons ?

Teacher assessed the previous knowledge of students




Introduce topic

2 min

INTRODUCTION Poisoning is one of the important accidental hazards among children. It may occur through ingestion, inhalation, injection or skin contact of poisonous substances. The children below five years of age are the common victim of this problem. It may occur as acute exposure of poisonous substance or may also occur due to chronic exposure of poisons. Accidental poisoning in children is a serious challenge to the health care due to its continuing

Teacher give introductio n of poisioning -

morbidity and morality. Most cases of accidental poisoning are preventable .Nursing personals are mostly responsible for the preventive measures to be taken at hospital and home. Health education is considered as the vaccine for prevention of accidental poisoning like other accidental hazards.


To define poisoning?

1 min

DEFINITION OF POISONING  Exposure to a chemical or other agent that adversely affects functioning of an organism.  Circumstances of Exposure can be intentional, accidental, environmental, medicinal or recreational.  Routes of exposure can be ingestion, injection, inhalation or cutaneous exposure. Teacher explain the definition of poisoning with the help of LCD LCD What do you mean by poisoni ng?


To define the poison? 1 min

Poison: The poison has its origin from old Teacher French where it means MAGIC explain POTION.  The dictionary meaning of the word poison means: a substance that causes death or injury when swallowed or absorbed by a living organism.  A poison is any substance that if taken into the body in sufficient quantity, can cause temporary or permanent damage. with the help of LCD LCD What is poison?


To explain the classificatio n of poisoning?

3 min

CLASSIFICATION: Poisons are classified according to the action they produce:  Corrosives.  Irritants.  Neurotics.  Others i. CORROSIVES: They are the poisons, which destroy the tissues by their direct chemical reaction. E.g. strong mineral acids, their carbonates and alkalis. Dilute mineral acids are corrosives but act as irritants. Teacher explain the classificati on with the help of flash cards. Flash cards Enlist the types of poison?

ii. spinal cord and nerve endings) and also on the heart. produce injurious effects like delirium. castor seeds. lead. copper. IRRITANTS: They are the poisons which by their specific action set up irritation and inflammation. mercury. iodine. insect bite (scorpion bite). Metallic: arsenic.  Animal Secretions: snake venom. coma. Colocynths. and abortifarients like ergot etc. zinc.  Organic Acids: oxalic acid. They are of following types:  Inorganic:   Non metallic: phosphorus. acetic acid etc.  Mechanical:     Powdered glass Diamond dust Chalked hair Dried sponge poisons which by their specific action on the nervous system (brain.  Organic:  Vegetables: aloes. bromine. NEUROTICS: They are . Teacher explain the classificati on with the help of flash cards What include s in corrosi ves poisioni ng? iii. croton oil.

tobacco etc.titanic spasm. symptoms of syncope or asphyxia etc. Cardiac Poisons: Digitalis. alcohol. Empty stomach absorbs quicker. In particular cases the vegetable irritants are absorbed from duodenum and upper part of intestine.g.  Inhalation through air passages (bronchial mucosa).  Delirients e. OTHERS:  Cerebral Poisons: barbiturates etc.    Spinal Poisons: Nuxvomica. To describe the routes of taking poison? 2 min  Orally i. carbolic acid etc.  Inebriants e.e. Asphyxiants: Poisonous irrespirable gases like CO2 . Teacher explain the classificati on with the help of leaflets leaflets Define the route of poisioni ng ?  Narcotics e.g. opium. . CO. by ingestion: to be principally absorbed from the gastric mucosa. coal gas.  Anesthetics e.g.g. datura cannabis etc. chloroform ether etc. ROUTES OF TAKING POISON: 7.

eye etc. To explain the sign and symptoms of poisoning? 3min SIGNS AND SYMPTOMS OF POISONING: These vary. Absorption through skin either intact or broken. To explain the the channels of elimination? 1 min CHANNELS OF ELIMINATION: Primarily. Stool and bile. & other mucous and serous secretions. Application on a wound. vagina. These are: Teacher explain sign and symptoms with the help of pamphlets pamphl ets What are general sign and sympto ms of  Delirious convulsions without previous history of such conditions . Saliva. Milk.e. Spinal route i. Application surface. depending on the nature of the poison and the method of their entry into the body. the poisons are eliminated through:    Urine (by kidneys). Introduction into the natural orifices such as rectum. Teacher explain with the help of LCD LCD What are channel s of elimina tion 9. sweat etc. urethra. intrathecal injection. Injection into the blood vessels or into the subcutaneous tissues. to a serous      8.

 Confusion. uraemia.  Corrosive Poisons: marks of corrosive will found externally.  Drowsiness. Abdominal pain. head injury. intestine or some other internal organs or intestinal obstruction causing peritonitis etc. meningitis.  Double vision. Special Symptoms: They differ according to the nature and class of poison.  Bluish lips.  Diarrhea. cerebral malaria etc.  Difficulty breathing. diabetic coma. gastroenteritis.  Headache. epilepsy.  Heart palpitations.  Dizziness.  Irritants: symptoms may be mistaken for cholera. perforation of stomach.  Cough.  Chest pain.  Fever. Teacher explain sign and symptoms with the help of pamphlets poisoni ng? .  Cerebral Poisons: symptoms may be mistaken for apoplexy.

hydrochloric acid.Cardiac Poisons: symptoms may stimulate heart failure. Burning in the mouth.  Treatment:  Do not induce vomiting in order to prevent perforation.  Stomach tube should never be used as there is a great risk of perforation. sulphuric acid.  Symptoms:   Burns on or around the lips.  Intense thirst. which will cause rupture of stomach by distension.  The incidence is suicidal or homicidal or may be accidental. throat and stomach often followed by heavy vomiting. 10.  Give half liter of water or milk to which milk of magnesia types with the help of LCD LCD Teacher explain What is include d in acid poisoni ng? . To describe the types of poisoning? 20 min TYPES OF POISONING:   Acid Poisoning: Acids which are used.  Strong alkalis (carbonates) should not be used because they will evolve CO2 . nitric acid. oxalic acid and acetic acid.

detergents.  The incidence may be either suicidal or accidental.   Alkali Poisoning: Alkalis commonly used are ammonia. Vomiting may contain blood and mucus.  Vegetable acids in a much diluted form like table vinegar (acetic acid).  There may be soapy appearance in the mouth. citric Acid. white of egg and barley water can be given. tartaric acid. bleachers. ordinary lemon juice etc.  If milk or water is not available then olive oil.   Abdominal pain. barley. washing soda etc. butter. potassium hydroxide and sodium hydroxide. should be used to counter act the effect.  Treatment:  Stomach tube and emetics should never be used.  Symptoms:  Membrane of the mouth may be white and swollen.  Demulcents like milk. What is treatm ent for alkali What are sympto ms of alkali poisoni ng? .(50gm) has been added.

Atropine sulphate is also given to reduce the motility of stomach.  Inj. exert a considerable buffering action against alkalis. olive oil etc is given.  In case of edema of glottis tracheostomy may be needed. Nausea & vomiting. such poisoning is common in children  Symptoms:   Pain in throat and abdomen.  Inj. steam is given to inhale and anodynes for pain. poisioni ng? Enlist the commo .  Common Indian Plant Poisoning: i.white of egg. egg white etc. complications like esophageal structure may have to be dilated. Castor Oil Plant.  In case of poisoning by Ammonia vapor. Protein containing foods like milk. Cortisone may be given to prevent its occurrence.  When the acute episode is over. Morphine sulphate is administered for pain.

Marked increase in appetite. tingling and numbness. Inj.  Administration of I/V fluid. Morphine Sulphate is given for pain. milk or egg white and induce vomiting.   Gastric lavage. vomiting and gripping pain. hashish is used. In large dose respiratory failure and death may occur. Treatment:  Give plenty of water and induce vomiting.  Salivation. Dilated pupils and deep sleep. Euphoria. ii.  Treatment:  Give plenty of water. laughter. majun.  Symptoms:       Excitement. ganja. Cannabis Sativa: Bhang. Giddiness. throat and abdomen. Visual hallucination. iii. n Indian plant poisioni ng? . Homicidal tendencies.    Narcosis. Jamal Gota:  Symptoms:  Burning pain in mouth.

 Convulsions and coma. fluids orally and induce vomiting. Dry mouth and throat. DHATURA or KALA DHATURA. Dhatura: It is either SAFED .   Giddiness.  Muttering delirium tries to run away from bed. rise in temperature. ataxia. Induce vomiting. Cocaine: This is obtained from coca plant.  Symptoms:  Difficulty in swallowing.  Treatment: Give plenty of iv. Treatment:   Give plenty of fluids. Dry hot skin. Burning pain in the stomach.  Develops dreadful hallucinations of sight and hearing.  Symptoms:     Bitter taste. Difficulty in swallowing and talking.  Tries to pull imaginary threads from tips of his fingers. v. Dried leaves and dried seeds are used as poisoning.

Vertigo. salivation. Vomiting.  Symptoms:    Burning of throat and stomach. Aconite: also known as MITHA ZEHER. Vomiting.  Treatment:  vi. Mushroom Poisoning: Poisonous mushrooms may grow wherever non poisonous mushrooms grow. Give plenty of fluids to induce vomiting. mouth. tongue and throat. Impairment of vision. Pain in abdomen. Abdominal colic. vii. Give plenty of fluids and induce vomiting. Rapid pulse dilated pupil.  Treatment:  .  Symptoms:  Severe burning and tingling of lips. Vomiting. Salivation. Muscle spasm and twitching. DUDHIA VISH. Diarrhea. Pain in abdomen.       Dysphagia.      Difficulty in speaking.

Convulsions in children. Fast pulse.  Symptoms: a) Stage of Euphoria:     Increased sense of well being. Thebaine.  Itching all over the body. Opium has a number of alkaloids (about 25) chief of which are Morphine.       Diarrhea Urine may contain blood. c) Stage of Narcosis:  Coma. rapid pulse. Coma. Convulsions. Codeine. Cyanosis. giddiness.  Desire to sleep. Induce vomiting. Castor oil should be given to drink. cramps.  Giddiness. Opium: It is also known as AFIM. . b) Stage of Stupor:  Headache. Papaverine. Narasine etc.  Cyanosis. Narcotine.  Treatment:   viii. Visual disturbances. Headache. Talkativeness.

Symptoms:  Euphoria.  Pinpoint pupil. Treatment:  The stomach is washed out first with plain water and the first wash is preserved for chemical examination.  Drug Poisoning: like phenobarbitone. treatment is virtually the same except that excision of the site of injection and washing the part with strong KMnO4 solution are the additional requirements. .  Body heat is maintained by hot water bags and warm blankets.  In case of Morphine poisoning by injection. mandra.  The patient is kept awake and is not allowed to sleep by flapping the chest and face with moist towels or by pulling the hairs. aspirin etc. Difficulty in respiration.  Bowel wash may be given with KMnO4 lotion as opium is excreted in the lower intestine. The idea of keeping the patient awake is not to allow him to go into the stage of coma.

 Drowsy.  Stools may be bloody dark in color.  In chronic poisoning.  Difficulty in breathing. Metal poisoning: Symptoms:  i.  Vomiting.  Profuse sweating.  Abdominal pain. drowsiness.  Vomiting is induced. cramps.  Giddiness. Lead:   Metallic taste in mouth.  Convulsions. Aspirin over dose:  Abdominal pain. numbness.  Ringing in the ears.  Nausea and vomiting. a blue line is seen on gums.  Plenty of fluids is given.  Headache. Treatment:  Give plenty of warm water. Talkativeness. .  Headache.  Treatment:  Hot coffee or tea is given.  Desire to sleep.

white of egg.  Chelating agents like calcium disodium versenate are very useful .  Accidental cases may happen due to douche or I/V injection of mercurial diuretics. ii.  Tongue and throat is corroded with grey white coating.  The stomach is washed with 1% solution of Magnesium or Sodium sulphate followed by water. Symptoms:  Metallic taste in mouth.  Inj. This method removes lead from tissues both in acute and chronic poisoning.  Burning pain in mouth and stomach. Milk.  Induce vomiting.  The chief poisonous salt of mercury is Mercuric Chloride. barley water can be given.5 ml of 20% solution in 250-500ml of NS or 5% glucose is administered by slow I/V drip taking an hour. . Morphine sulphate is given to relieve pain. Mercury:  Inhalation of mercury vapor is poisonous.

. Morphine Sulphate should is given for pain. Copper: Metallic copper is not a poisonous substance copper sulphate or blue virtol is a metallic irritant. rice.  Stool may be bloody dark in color.  Salt free diet is given i. iii. bread.  Orally pencillamine also provides a good antidote. As albumin of mercury is rapidly soluble in presence of NaCl and absorption of mercury is also favored in the presence of NaCl.  Mannitol is used to promote diuresis. Nausea and vomiting. milk. convulsions. It has replaced opium as a suicidal poisoning now days.  Inj.e.  Headache. because opium is not available without . stomach wash is effective.  Treatment:  Stomach wash: if the patient is seen within 1/2 hr. numbness.  I/V 5% glucose/saline should be given to correct dehydration.

 Coma. (color is bluish/ greenish)   Headache.prescription. It is considered to be as antidote as it produces insoluble copper albuminate. Burning pain in stomach. Vomiting.  Demulcents like egg albumin are given.  Sometimes convulsions. paralysis of limb.    Increased salivation and thirst. Morphine sulphate for  Treatment:  . Diarrhea with passage of liquid and browny stool. insensibility. No emetic is necessary as the patient started vomiting very soon.  I/V infusion of saline or glucose is needed to combat dehydration.  Inj.  Stomach is washed out with 1% solution of Potassium Ferro cyanide which forms insoluble cupric Ferro cyanide.  Symptoms:  Strong styptic metallic taste with a sense of constriction in the throat.

  Gastrointestinal problems.  Rashes.  Symptoms: a) Acute:    Pain.  Muscle and joint pain. Mood swings Memory loss c) Intermittent:  Flu-like symptoms. Mental confusion or disorientation. iv. Vomiting and bloody diarrhea.  Irritability. Metallic taste or Garlicky breathe odor. dyes and medicinal solutions.  Brittle nails.  Headaches. herbicides. b) Moderate:  Feeling of pins and needles in hands or feet. an ingredient in some pesticides.pain.    Headache. .  Fatigue. Arsenic poisoning:Toxic effect caused by the ingestion or inhalation of arsenic or a substance containing arsenic.

 Hydration with IV fluids to prevent dehydration and kidney failure. Vertigo. The chelating agents are Dimercaprol and Succimer  i. Paint thinner.  Symptoms:      Nausea and vomiting.  Treatment:  . Petroleum distillates: Diesel oil. Give plenty of water to induce vomiting. ii. Chelation therapy aids in removing the toxic chemicals from the body by attracting the atoms to the compound of the less toxic medication and thus expelling them from the body. Respiratory failure. Treatment:  Gastric lavage or whole-bowel irrigation. Coma. This is especially effective in treating cases of recent ingestion. Organic Chemical Poisoning: DDT: Dichloro diphenyl trichloroethane. Convulsions. Kerosene. tremors.

Artificial respiration may be necessary.    Excessive thirst. Convulsions.   Give stimulants and emetics. Wash out stomach with plain water. Vomiting. Symptoms:   Burning pain in throat. iii. Feeling of warmth in stomach.  Treatment:  .  Smell of oil is also present in urine and in stools.  Symptoms:    Pain in abdomen. Confusion. Naphthalene: Naphthalene is available in the form of balls which is used as moth repellant. colic.   Unconsciousness and collapse. Face may be paled or cyanosed.  High carbohydrate diet and Vitamin B complex is given to prevent damage to liver. Drowsiness.  Head end is kept low during stomach wash.

Dyspnea. dizziness. Convulsions. Cyanide:It is very lethal poison. Unsteady gait.  Amyl nitrite should be inhaled every 1-2minute. . Headache. Hypotension.  Stomach lavage with 5-10% Sodium Thiosulphate. Red conjunctivae. Coma.  Symptoms:     Flushed face. Respiratory failure.  Alcohol Poisoning: Methyl alcohol is commonly used. Excitement.  Treatment:  Start resuscitation immediately. Characteristic smell of bitter almonds. Convulsions. It can be taken via ingestion or inhalation. Foam in the mouth. Smell of alcohol in breathe.  Symptoms:         Headache. drowsiness.    iv. Cyanosis.

 Treatment:   11. Subnormal temperature. Teacher explain antidotes with the help of LCD LCD Define antidot es? . Face becomes cyanosed. Ammonia inhalation should be given.     Foolish speech. Gastric lavage should be done. Artificial respiration should be provided if required. Coma and shock.  Agents that counteract or neutralize the effect of poison. Cold and clammy skin.  Anything that counteracts or relieves a harmful or unwanted conditions. To explain antidotes? 30sec ANTIDOTES  These are agents that relieve or counteracts.

phenol poisoning . Urine tests – Urine should be examined for abnormal color.results shows Red color– exposure to salicylates Purple green – phenothiazine poisoning Voilet color Ketones alcohol 2. Ethylene glycol poisoning – oxalate crystals In this ferric chloride test may help in identifying the incriminated toxin . Like in Phenol poisoning.add 5-10 drops of freshly prepared 10% ferric chloride solution to 10 ml of boiled and acidified urine. To enumerate the laboratory diagnostics in poisoning? 2 min LABORATORY DIAGNOSTICS These tests provide an idea about Teacher the possible toxin before the reports of others tests are available:1.urine is smoky dark green color.exposure to explain laboratory diagnosis with the help of LCD LCD Enlist the laborat ory diagnos tic for poisioni ng? acetone salicylate and isopropyl . Blood tests – Blood tests are done for detection of poison like .12.

To explain the manageme nt of poisoning? 10 min MANAGEMENT Phases of management of children with poisoning Early suspicion and appropriate management forms the main stay of therapy. 13.5 ml-125 mg) to 1 ml gastric fluid leads to color change in iron poisoning. Pre-toxic phase.Then the decontamination is the highest priority and treatment is based on history. Blood appears chocolate color in patients melthemoglobinemia and pink in case of potassium cyanide poisoning  Measurement of anion gap and osmolol gap detects accumulation of unmeasured ions osmotically active agents in blood. Gastric aspirate – Addition of 2 drops of 30% hydrogen peroxide and deferoxamine (0. Teacher explain phases with the help of chart chart What are phases of manag ement of poisoni ng? . If the child is brought in the 1. The maximum potential toxicity based on greatest possible exposures should be assumed. 3.

2. The approach to child – Child who ingested poison is not only physically ill but is also emotionally distressed. It Teacher explain with the help of LCD LCD . Resuscitation and stabilization are the first priority. Resolution phase.The supportive care and monitoring should continue until clinical and laboratory abnormalities have resolved. The method for the immediate removal of the poison in the home. 1. The approach to child 2. General management of poisoning AT HOME When the parent or the baby sitter calls the emergency source for information about the care of a child who is poisoned . management is based primarily on clinical and laboratory findings. Toxic phase – The time between the onset of poisoning and the peek effects. Termination of exposure to the person 3. 1. the person who answer must stress . 3.

Termination of exposure to the person-Since the ingestion of addition poison would increase the danger .mouth should be removed promptly before it can swallowed and the soiled clothing should be replaced. because the amount of poison absorbed depends on the interval between its ingestion and its removal . Prompt treatment is necessary . The method for the immediate removal of the poison in the home – The immediate treatment of poisoning is caused.is also important for the parents or baby sitter to remain calm so that the child can be comforted. 3. Contra indications of induction of vomiting  The poison is a strong What are the contrin dication s of inductio n of vomitin .any of the poisonous material remaining in the child .Excessive manipulation are to be avoided. by an ingested substance is to removed it by inducing vomiting while the child is still at home if this is not contraindicated. 2.

an emetic. 6. 2.corrosive (acid or alkali) which would further damage mucosa  The poison is hydrocarbon . 4. Specific antidote therapy.  The child has lost the gag reflex or is in severe shock . Emergency stabilization measures. is unconscious.which would cause hydrocarbon pneumonia if aspirated. This drug is effective because it stimulates the vomiting center and also has an irritating effect on the mucosa of stomach . Removal of poisonous substance and toxin. Counseling to parents and g? Name the syrup given to induce vomitin g? . AT HOSPITAL 1.The amount of the drug given depends on the child’s age. 3. VOMITTING is induced by administering syrup of IPECAC . 5. or is convulsing Or any of which could increase the danger of aspiration. Supportive therapy. Identification of poison.

respiratory depression and pupillary constriction . repeated if needed. Circulation – Fluid boluses. a trial of naloxene should be given before intubation . air entry and oxygen saturation. chest movement.Bag and mask ventilation is associated with higher risk of aspiration .This can be minimized by synchronized and gentle ventilation and aspiration of gastric contents prior to ventilation . Breathing.neck and facial injuries or angioedema. B. EMERGENCY Airway maintenance STABILIZATION MEASURES.In any child with altered mental status .children Steps of management 1. under monitoring for fluid . A. C.Adequacy of breathing should be assessed by respiratory effort. Establishing airway may be difficult in children with poisoning due to caustic and thermal upper airway injuries .

Neutralization of an agent (using alkali for acid exposure or vice versa) is harmful and contra-indicated.overload .constitute the initial management of shock particularly in poisoning due to cardio toxic agents and children with cardiopulmonary diseases. all clothes should be removed and the contaminated area washed with liberal amount of water and soap.  GI decontaminationGastric emptying is a cardinal principal of management of . dopamine is the agent of choice except in poisoning due to tricyclic antidepressant. In patient with corrosive burns and organophosphorous poisoning. 2. Laboratory investigation for detection of or identification of poison. In an unresponsive shock. 3. Prevention of further absorption of poison  Dilution – This involves application of water in an effort to reduce toxin.The mechanism depends upon the site of exposure.

ingested toxins. Orogastric lavage may be considered for uncommon situations.with whole bowel irrigation being used for a few indication.Activated charcoal . The drug is available as a 400 mg tablet and should be crushed before administered.It is contraindicated in corrosive poisioning.  Binding agents.   Cathartics Whole bowel irrigation 4.if needed.clays .The procedure of choice for decontamination . The desired outcome is prevention of continued absorption of poison from the gut into the bloodstream in asymptomatic children . and cholysteramine may be used at a dose of1-2 g/kg.Enhancing eliminationProcedures directed toward enhancing elimination is . is activated charcoal .Gastric lavage should be performed only after the gag reflex has been assessed. made into slurry and administered. The role of gastric lavage in children is not clear.

 Manipulation of pH and dieresis  Dialysis  Exchange transfusion 5. Indications for intensive care include Evidence of severe poisoning. Antidotes significantly reduce the morbidity and mortality. coma.indicated in patients with significantdelay following poisioning or hen methodsfor prevention of absorption are ineffextive or not applicable.The goals of supportive therapy include maintenance of hemostatasis and prevention and treatment of complication. hypotension.Supportive therapy. 6. but are potentially toxic.Administration of antidotes – antidote counteract the effects of poisons by neutralizing them or by antagonizing their physiological effects. cardiac conduction abnormalities.   Need for antidote or Progressive clinical enhanced elimination therapy . respiratory depression.

Robert. . U.S. Basu.editon fourth published by lange medical .publishers. (1963)” Handbook of poisoning’. 14.A.S.deterioration. To refer more books BIBLIOGRAPHY Derisbach.. To recapitalize the topic 5 min RECAPITUALIZATION Q-Define poisioning? Q-Enlist typesof poisioning? Q- Teacher ask the question and students actively participate - 16.C. (1995)” Hand book of medical jurisprudence and . To summarize the topic 2min SUMMARIZATION Today we have discussed Introduction Definition of poisionind? Definition of poison? What is classification of poison ? Describe the management of children with poisioning at home? Teacher summariz e the topic - 15. pp 2 -16.H.

”2007. Gupta.Pp-676-680 .L. pp 277283. abhitabh (1995) manual of first aid . Calcutta. pp 148-151. Datta parul.edition first published by jaypee brothers medical publishers (p) ltd. Indrani.K. new delhi. pp 235-250.published by jaypee brothers medical publishers.Pp Ghai op . (p) ltd.C. New Delhi. and gupta.”Peadiatric Nursing.CBC publishers. 348-356.1 st edition.(2003)” First aid for nurses “edition first. 294-310.”(2009) 7 th edition.Jaypee publishers.T. “Essential peadiatrics.toxicology” edition second published by current distributers.

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