1. First Aid & Decontamination
DR RAJESH K
ASST PROF & INCHARGE
DEPT OF EM
SRI DEVARAJ URS MEDICAL COLLEGE,KOLAR

2. Welcome All to virtual EM Andhra 2021

3. Best wishes to all the real hero @
crucial exigency of covid pandemic

4. “Poison is everything, and no thing is without
poison, the dosage makes it either a poison or
a remedy “ paracelsus

5. History of poison
• The history of poison stretches from before 4500
BCE to the present day.
• Poisons have been used for many purposes across
the span of human existence
•
Indian surgeon Sushruta defined the stages of
slow poisoning and the remedies of slow
poisoning

6. History of poison
• Today, poison is used for a wider variety of
purposes than it used to be.
• Pesticides: have known to be used in some form
since about 2500 BC.
• The use of pesticides has increased staggeringly
from 1950, and presently approximately
2.5 million tons of industrial pesticides are used
each year.

7. Statistics
• The NCRB recorded 133,623 deaths from suicide
in 2015 , of which 23,930 (17.9%) were due to
pesticides.
• 1995 to 2015, there were 2,451,410 suicides from
all methods and 441,918 pesticide suicides
(18.0% of the total) recorded in India.
• Maharashtra, Andhra Pradesh, Madhya Pradesh,
Tamil Nadu, West Bengal, Kerala, Telangana,
Karnataka, Gujarat, Odisha and Chhattisgarh.

8. Statistics
• States account for approximately 54.1% of the
total population of India, and 84.2% of suicides
by all methods in India.
• In 2015, The Anupam Verma Committee to
review the continued use of 66 pesticides that
have been banned or restricted for farming use in
other countries.
• In 2016, it recommended a ban on 13 pesticides,
phasing out of 6 pesticides by 2020,

9. Prehospital Care Of Firstaid
• Pre hospital care of someone who may have
been poisoned depends on:
• The person's symptoms
• The person's age and body weight
• Whether you know the type and amount of
the substance that caused poisoning

10. When to suspect poisoning
• Poisoning signs and symptoms can mimic various
clinical conditions…
• Burns or redness around the mouth and lips
• Breath that smells like chemicals, such as gasoline
or paint thinner
• Vomiting
• Difficulty breathing
• Drowsiness
• Confusion or altered mental status

11. What to do while waiting for help
• Swallowed poison: Remove anything remaining in the person's
mouth.
• Poison on the skin: Remove any contaminated clothing.
• Poison in the eye: Gently flush the eye with cool or lukewarm.
• Inhaled poison: Get the person into fresh air .
• If possible collect: pill bottles, packages or containers with labels
about the poison to send along with the ambulance team.

12. National Poison Information Centre
(24x7)
• 011 26589391
• 011 26593677
• Toll free number: 1800116117

13. Decontamination
• Decontamination refers to practice of limiting or
minimizing the exposure of a patient to a
ingested toxin.
• Benefits of Decontamination:
A. Prevention of further exposure
B. Prevention of secondary contamination
C. Prevention of contamination of the health care
facility.

14. Decontamination
• Decontamination efforts are initiated by first
responders, including HAZMAT teams.
• The managing patients with HAZMAT are to
protect the health care providers.
• The level of PPE is classified according to
Environmental protection agency A to Z.

15. Types of decontamination
• Many approaches have been adopted
• Gastric Evacuation
1. Gastric Lavage
2. Intra Gastric Binding
3. Whole Bowel Irrigation
• Enhanced Elimation
1. Hemodialysis
2. Hemoperfusion
3. Hempfiltration

16. Gastric Decontamination
• GI decontamination is a highly controversial
issue in medical toxicology.
• In 1997 Publication of position statement
lavage/induced emesis/WBI by AACT and
EAPCCT.
• The overall trend in decontamination is
continually declining.

17. OGL is done to remove substantial toxin
before absorption or diminish its efforts.
• INDICATIONS
a) Significant amount of toxin in GI tract.
b) Ingested toxin non absorbable.
c) Toxin exceeds the absorbable quantity.
d) No known contraindications.

18. Contraindications
• Doesn’t meet criteria for lavage.
• Risk of airway protection.
• Toxin with higher aspirational protection.
• Ingestion of alkaline caustic.
• Ingestion of foreign body
• Risk of perforation because of underlying
pathology/medical condition.

19. Technique of OGL
• Select correct tube size
• Check airway patency
• Better keep patient in left lateral decubitus
position.
• Proper length of tube to inserted and confirm
the position.
• In adults 250ml and children 10-15ml to max
of 250 ml.

20. Whole Bowel Irrigation
• A method of purging the GI tract in an attempt
to expeditiously achieve gut clearence to
prevent further absorption of toxin.
• No new evidence in position papers on WBI.
• Cant be done if the GI tract is adynamic or
obstructive ileus.

21. WBI remain theoretical because the only support for efficacy
comes from surrogate markers and anecdotal experience
Indications
• Toxins ingestion of
sustained release.
• Toxic amount of toxin not
adsorbed to AC.
• Removal of ilicit drug
packets from body packers.
Contraindications
• Absent airway reflexes.
• GI tract is not intact.
• Persistent vomiting.
• Signs of leakage from
cocaine packets.

22. Decontamination
• Dermal exposure.
• Ophthalmic exposure.
• Inhalational exposure.

23. Enhancing elimination
• Metal chelators.
• Resins
• Hemodialysis
• Hemofiltration
• Hemoperfusion
• Liver support devices
• Plasmapheresis.

24. General Indications
• Patients who fail to respond to comprehensive supportive care.
• Patients in whom the normal route of elimination is impaired.
• Patients in whom the amount of toxin absorbed or its high
concentration in serum indicates that seriously ill.
• Patients with concurrent disease.
• Paitents with concomitant electrolyte disorders that can be
corrected by hemodialysis.

25. References
• Goldfrank’s Toxicologic Emergencies 11E.
• mayoclinic .org
• www.Uptodate.com

27. Thanks EM ANDHRA for opportunity