PERTOLONGAN PERTAMA

PADA KERACUNAN
KERACUNAN
DEFINISI :
Adalah kejadian dimana organisme hidup kontak dengan zat
beracun dan mempengaruhi fungsi organisme mahluk hidup tsb.
Toxicology:
Ilmu yang mempelajari efek yang kurang baik dari racun pada
mahluk hidup/organisme hidup

What is a Poison?
All substances are poisons;
there is none that is not a poison.
The right dose
differentiates a poison and a remedy.

Paracelsus (1493-1541)
 The study of the adverse effects of a
toxicant on living organisms
• Adverse effects
– any change from an organism’s normal state
– dependent upon the concentration of active
compound at the target site for a sufficient time.
• Toxicant (Poison)
– any agent capable of producing a deleterious
response in a biological system
• Living organism
– a sac of water with target sites, storage depots
and enzymes
 Dose
The amount of chemical entering the body
This is usually given as
mg of chemical/kg of body weight = mg/kg
The dose is dependent upon
* The environmental concentration
* The properties of the toxicant
* The frequency of exposure
* The length of exposure
* The exposure pathway
 Exposure: Pathways
• Routes and Sites of Exposure
– Ingestion (Gastrointestinal Tract)
– Inhalation (Lungs)
– Dermal/Topical (Skin)
– Injection
• intravenous, intramuscular, intraperitoneal

• Typical Effectiveness of Route of

Exposure
iv > inhale > ip > im > ingest > topical
 Exposure: Duration
Acute < 24hr usually 1
exposure
Subacute 1 month repeated doses
Subchronic 1-3mo repeated doses
Chronic > 3mo repeated doses

Over time, the amount of chemical in the

body can build up, it can redistribute, or
it can overwhelm repair and removal
mechanisms
7 Langkah Penatalaksanaan Keracunan :

1. Resusitasi dan stabilisasi .

2. Evaluasi klinis dan difinitiv diagnosa.
3. Dekontaminasi.
4. Absorbsi racun dengan eleminasi.
5. Antidotum.
6. Perawatan suportif.
7. Disposisi.
RESUSITASI DAN STABILISASI.

Airway
Breathing
Circulation
EVALUASI KLINIS DAN DEFINITIF DIAGNOSA.

ANAMNESA :
- BAGAIMANA RACUN MASUK TUBUH :
- JUMLAH RACUN YANG MASUK.
- SUDAH BERAPA LAMA KONTAK.
- PERTOLONGAN PERTAMA YANG SUDAH DIBERIKAN.
- PROFIL PSYKOLOGI PENDERITA.
- GEJALA YANG TELAH DIALAMI PENDERITA.
 Common Physical Signs in Toxicology
Likely Causative agent
Physical signs
Coma; drowsiness Alcohol, antidepressants, antihistamines, antipsychotics,
barbiturates and other sedatives, narcotics, salicylates
Breath odour Alcoholic breath: Ethanol
Smell of garlic: Arsenic, organophosphates, phosphorus
Odour of bitter almonds: Cyanides
Smell of acetone: Isopropanol, nail polish remover, salicylates
Pungent odour: Ethchlorvynol
Fragrance of violets: Turpentinne
Smell of oil of Wintergreen: Methylsalicylate liniment
Pearl-like odour: Chloral hydrate
Miscellaneous typical odours: Ammonia, kerosene, petrol,
petroleum distillates, phenol
Eyes Mushrooms (muscarinic properties), narcotics, organophosphates
Pupils: Amphetamines, antihistamines, atropine, barbiturates, cocaine,
Constricted glutethamide, Lysergic acid Diethylamide (LSD), methanol, opiate
(miosis) withdrawal, tricyclic antidepressants
Dilated Barbiturates, PCP, phenytoin, sedatives
(mydriasis) Botulism, digoxin, methanol, organophosphates
Nystagmus Alcohol, cocaine, LSD, mescaline, PCP
Visual disturbance
Visual
hallucinations
Mouth: Amphetamines, antihistamines, atropine, narcotics
Dry Arsenic, corrosives, mercury, mushrooms, organophosphates,
Salivation strychnine.
Gum discoloration Lead, other heavy metals

Respiration: Amphetamines, barbiturates (early effect), methanol, petroleum

Rate increased distillates, salicylates
(>20/min) Alcohol, barbiturates (late effect), narcotics
Rate decreased Botulism, organophosphates
(<10/min) Narcotics, organophosphates, petroleum distillates
Respiratory
paralysis
Wheezing/pulmon
ary oedema
Heart Rate: Digitalis, narcotics, sedatives
Bradycardia Alcohol, amphetamines, atropine, cocaine, salicylates
Tachycardia
Gastro-intestinal: Arsenic, heavy metals, lead, mushrooms, narcotic withdrawal,
Abdominal Colic organophosphates
Constipation Lead, narcotics
Diarrhoea Arsenic, boric acid, iron, mushrooms, organophosphates
Vomiting Boric acid, caffeine, corrosives, heavy metals, phenol, salicylates,
(sometimes theophylline
bloody)
Skin: Barbiturates, carbon monoxide
Bullae Carbon monoxide, nitrites, strychnine
Cyanosis Arsenic, carbon tetrachloride, castor bean, mushroom (delayed
Jaundice effect), paracetamol (delayed effect)
Needle marks Amphetamines, narcotics, PCP
Purpura Salicylates, snake bites, spider bites
Redness and Alcohol, antihistamines, atropine, boric acid, carbon monoxide,
flushing of skin cyanide
Sweatiness Amphetaminess, barbiturates, cocaine, LSD, mushrooms,
organophosphates

Neuromuscular: Alcohol, amphetamines, antihistamines, barbiturate withdrawal,

Fasciculations/ chlorinated hydrocarbons, cyanide, isoniazid, lead,
convulsions methaquolone, organophosphates, phenothiazines, plants (a
Paralysis number of), salicylates, strychnine, tricyclic antidepressants
Ataxia Botulism, heavy metals
Alcohol, barbiturates, bromides, hallucinogens, heavy metals,
organic solvents, phenytoin
 DEKONTAMINASI :

A. DEKONTAMINASI MATA DAN KULIT.

B. DEKONTIMASI PERNAFASAN.
C. DEKONTAMINASI GIT
Dekontaminasi.
 DEKONTAMINASI MATA DAN KULIT.

• PERLINDUNGAN PENOLONG.
LATEX GLOVE , PASTIC GOGLE, MASKER, SCORT.

. PROSEDURE :
- PINDAHKAN KORBAN DARI TKP.
- SEMPROT/CUCI MATA DAN SELURUH TUBUH DENGAN AIR
BERSIH SELAMA 2 – 5 MENIT.
- UNTUK MATA DITERUSKAN SAMPAI 10 – 15 MENIT.
- SEMUA PAKAIAN HARUS DILEPAS DAN SELURUH PERMUKAAN
KULIT HARUS DICUCI DENGAN SABUN SELAMA 10 – 15 MENIT.
- JIKA SUDAH ADAD LEPUHAN KULIT/BLISTER, DITABURI DENGAN
FULLER’S EARTH / ATTAPULGITTE, BILAS DENGAN AIR 10 MENIT.
- JIKA TANGAN PX IKUT TERKONTAMINASI , KUKU AGAR DISIKAT
SECARA HALUS.
- JIKA PROSEDUR DIATAS SELESAI , BERI PAKAIAN KERING.
.
 Treatment
• For clinical purposes
• all toxic agents  two classes :
• 1. specific treatment or antidote
• 2. no specific treatment
• ↓
• supportive therapy is the mainstay of the
• treatment of drug poisoning
• "Treat the patient, not the poison,"
• ↓
• the most basic and important principle of clinical toxicology
• symptomatic medical care that supports vital functions is the only strategy
• Goal of treatment
• 1.to maintain the vital functions if their impairment is imminent
• 2.to keep the concentration of poison in the crucial tissues as low as possible by :
• -preventing absorption
• -enhancing elimination
• 3.to combat the pharmacological and toxicological effects at the effector sites.
 PERTOLONGAN PERTAMA
• Poisoning.

• Bite and Sting

Do no harm
 Human bites
first aid
• If you sustain a human bite that breaks the skin:
1. Stop the bleeding by applying pressure.

2. Wash the wound thoroughly with soap and water.

3. Apply an antibiotic cream to prevent infection.

4. Apply a clean bandage.

When?
5.Get emergency medical care
 Domestic pets
first aid
If you or your child is bitten by an animal, follow these guidelines:
1-If the bite barely breaks the skin, treat it as a minor wound. Wash the wound
thoroughly with soap and water. Apply an antibiotic cream to prevent
infection and cover it with a clean bandage.

2-If the bite creates a deep puncture of the skin or the skin is badly torn and
bleeding, apply pressure to stop the bleeding and see your doctor.
. When ?
* If you notice signs of infection such as swelling, redness, increased pain
or oozing, see your doctor immediately.
* If you suspect the bite was caused by an animal that might harbor rabies
— any unprovoked bite from a wild or domestic animal of unknown
immunization status — see your doctor immediately.
• Doctors recommend you get a tetanus shot every 10 years. If your last one
was more than 5 years ago and your wound is deep or dirty, your doctor
may recommend a booster. You should have the booster within 48 hours of
the injury.
Snake bites
Ular berbisa
Ular yang tidak berbisa
SNIKE BITE first aid
-CUCI DAERAH/TEMPAT YANG TERGIGIT DENGAN
SABUN / DETERGENT

-Terbaru BEBAT TEKAN

- Sarankan pasien tetap tenang dan hindari gerakan yang
tidak perlu
 Ptrotap negara australia
• Quickly tie a light restricting band both
above and below the bite area a few
inches away from the puncture/bite marks.
1. Apply a broad pressure bandage over the bite
site as soon as possible.
2. Keep the limb still. The bandage should be
as tight as you would bind a sprained ankle.
3. Extend the bandage down to the fingers or
toes then up the leg as high as possible. (For a
bite on the hand or forearm bind up to the
elbow).
4. Apply a splint if possible, to immobilise the
limb.
5. Bind it firmly to as much of the limb as
possible. (Use a sling for an arm injury).
 Scorpion sting
first aid
• Wash bite with soap and water and
remove all jewelry.
• Apply cool compresses.
• Acetaminophen (Tylenol) 1-2 tablets every
4 hours may be given for pain.
 Bee string
Honey bee < warp < hornet : first aid
• For mild reactions:
1. Move to a safe area to avoid more stings.

2. Try to remove the stinger by scraping or brushing it off with a firm

edge, such as a credit card. Swab the site with disinfectant.

3. To reduce pain and swelling, apply ice or a cold pack.

4. Apply 0.5 percent or 1 percent hydrocortisone cream, calamine lotion

or a baking soda paste to the bite or sting several times a day until
your symptoms subside.

5. Take an antihistamine such as diphenhydramine (Benadryl, Tylenol

Severe Allergy) or chlorpheniramine maleate (Chlor-Trimeton, Teldrin).
• For severe reactions:
Severe reactions may progress rapidly. Dial *** or call for
emergency medical assistance if you experience any of the
following signs or symptoms:
• Difficulty breathing

• Swelling of the lips or throat

• Faintness

• Confusion

• Rapid heartbeat

• Hives

• Nausea, cramps and vomiting

 first aid
• While waiting for emergency transportation:
1. Have the person lie down. If unconscious and breathing, lay the
person on his or her side to allow drainage from the mouth.

2. If there is no breathing, movement or response to touch, begin

cardiopulmonary resuscitation.

3. Check to see if the person is carrying an allergy kit containing

epinephrine. Follow instructions on the kit.
 Jelly fish
first aid
• Remove the victim from the water.
• Rinse the affected area with salt water or don’t rinse it at all. Do not
rinse the involved area of skin with fresh water, because it will
further activate nematocysts and worsen the reaction.
• Using protective gloves or forceps, remove any tentacles still in
contact with the victim.
• Apply acetic acid 5% (white vinegar). This will inactivate
undischarged nematocysts and the toxin and will help to decrease
symptoms.
• Use over-the-counter pain medications such as acetaminophen
(Tylenol) or ibuprofen (Advil, Motrin) to control pain symptoms.
Immobilize the area that was poisoned to prevent further spread. For
example, if a foot was stung, encourage the victim to keep the area
still with as little movement as possible.
 Prevention
• Poison
• Sting & bites
GO