Intensive Care of Acute Poisoning - A. V. Hovenko 2010

Modern approaches to the diagnosis of acute poisoning
Clinical diagnosis of acute poisoning

First responders at the scene must determine the cause and time of poisoning, the type of toxic substance, its quantity and concentration, and the route of entry into the victim's body. These findings must be recorded in the accompanying documents and the patient's medical history. To identify the toxic substance, a sample is sent to a toxicological laboratory. Containers with liquid must be transported tightly sealed with a stopper or lid. Cotton or gauze swabs must not be used for this purpose. When performing gastric lavage, the first portion of the washings (100–150 ml) should be collected in stoppered bottles. In the hospital, prior to initiating intensive therapy, Blood and urine samples must also be collected in tightly stoppered or capped vials for subsequent analysis in the toxicological laboratory.

Patient examination takes into account:

1. Patient Complaints.

2. Duration of exposure to the toxic substance.

3. Circumstances of the poisoning.

4. General condition of the patient.

5. Neurological examination findings: level of consciousness, body posture, behavior, agitation, pupil size and reactivity, Reflexes, pain sensitivity, hyperkinesia, seizures, and myofibrillation.

6. Condition of the Skin: color, moisture, and turgor.

7. Condition of the mucous membranes: color, moisture, and presence of Burns.

8. Respiratory status: respiratory rate and rhythm, bronchorrhea, bronchiolospasm, odor of exhaled air, and presence of rales.

9. Gastrointestinal status: nausea, vomiting, odor of vomitus, abdominal wall rigidity, abdominal tenderness upon Palpation, and characteristics of stool.

10. Urinary System status: Pasternatsky's sign, urine color and output, Hematuria, oliguria or anuria, and proteinuria.

During the physical examination, clinicians identify which symptom is primary among the various clinical manifestations of Acute Poisoning. The clinical picture of acute poisoning is determined both by the selective toxic damage to specific Organs and systems—which is characteristic of each toxicant—and by systemic functional disorders throughout the body.

The clinical course of acute poisoning comprises four periods:

a) latent period—from the moment the poison enters the body until the first signs of poisoning appear;

b) period of escalating resorptive effects—from the appearance of the first signs of poisoning to The Development of a full-blown clinical picture;

c) period of peak resorptive effects;

d) recovery period.

Understanding the phased progression of poisoning enables targeted Differential Diagnosis and appropriate therapy.

Thus, at the scene of the incident, it is essential to determine the cause of the poisoning, identify—if possible—the type of toxic substance, its quantity, route of entry into the body, the time of poisoning, and the concentration of the toxicant in solution or the dose of medications. Emergency medical personnel or other first responders must report these data to the attending physician at the hospital where the acute poisoning patient is admitted.