Tiêu đề 3. SUPPORTIVE CARE IN CLINICAL TOXICOLOGY.pdf ✅

PHARMD GURU Page 1 SUPPORTIVE CARE:  Supportive Care Supportive care is provided to poisoned patient to keep the patient alive until the physiological function is restored by further specific treatment.  Supportive care helps people meet the physical, practical, emotional and spiritual challenges. It is done by monitoring the physiologic functions and correct significant deviations from normal.  During this course of action anticipate and try to prevent complications. Initial resuscitation should be based on the assessment of the patient and not the particular toxin involved and standard advanced life support (ALS) guidelines should be followed.  Specific instances where treatment may differ are indicated below.  The majority of patients taking overdoses or with drug toxicity is young and healthy, so cardiac and respiratory support should be continued for much longer periods of time in patients with a toxicity-related cardiorespiratory arrest.  If there is any doubt, cardiac compression and ventilatory support should be continued until the situation has been discussed with a clinical toxicologist.  There has been survival with normal neurological function in patients receiving cardiopulmonary resuscitation (CPR) for hours.  It mainly includes the following stages : 1. AIRWAY (A) 2. BREATHING(B) 3. CIRCULATION(C) 1. AIRWAY:  Monitoring and managing airways and breathing is crucial in the treatment of poisoning. SUPPORTIVE CARE IN CLINICAL TOXICOLOGY
PHARMD GURU Page 2  CNS depression is a common effect of drugs, so regular and careful assessment of airway protection and patency is important.  The immediate need for assisted ventilation has to be assessed clinically, but the efficiency of ventilation can only be gauged by measuring the blood gases.  Some drugs stimulate the respiratory centre. Eg. Amphetamines, Atropine, Cocaine, and Salicylates.  Some drugs are associated with non- cardiogenic pulmonary oedema, characterised by severe hypoxaemia, bilateral infiltrates on chest Xray, and normal pulmonary capillary wedge pressure. Eg. Calcium channel blockers, Anticoagulants, Beta-blockers, etc.  Some drugs cause or exacerbate asthma. The most important among them include NSAIDs, antibiotics like penicillins, cephalosporins, tetracycline, and nitrofurantoin, cholinergic drugs, chemotherapeutic drugs, and some diuretics. MANAGEMENT: 1. First establish an open airway:  Remove dentures (if any).  Use the chin lift and jaw thrust, to clear the airway obstructed by the tongue falling back.  Remove saliva, vomitus, blood, etc. from the oral cavity by suction or finger-sweep method.  Place the patient in a semi-prone (lateral) position.  If required, insert an endotracheal tube.  If ventilation is not adequate, begin artificial respiration with Ambubag. CHIN LIFT AND JAW THRUST METHOD

PHARMD GURU Page 4 exercises or meditation to help ease anxiety when you have trouble breathing. Make patient sit near an open window or in front of a fan to get extra air. Opening a window or lowering the room temperature may also help because cooler air is easier to breathe. OXYGEN THERAPY: Oxygen therapy is a treatment that gives extra oxygen. It makes sure patient gets enough oxygen if you have difficulty breathing. Patient breathe the oxygen in through a mask over mouth or through tubes in the nostrils. Oxygen therapy is usually only helpful if you have low levels of oxygen in your blood (called hypoxemia). THORACENTESIS: Thoracentesis may be used to drain an abnormal buildup of fluid in the space between the lungs and chest wall (called pleural effusion). The doctor inserts a hollow needle through the skin into the space between the lungs and the chest wall (called pleural cavity). PARACENTESIS: Paracentesis may be used to drain an abnormal buildup of fluid in the abdomen (called ascites). The doctor inserts a hollow needle or plastic tube (called a catheter) through the skin into the abdomen. The doctor uses the needle to drain extra fluid from the abdomen.