Come to baby toxic

Come to baby toxic Coma is the persistent loss of ability to wake up (vigilizare). In front of the coma is aimed at detecting toxic element that can be serious: respiratory depression, cardiovascular failure, impaired neurological lesion and depth.
Toxic Coma is a valid term for the first 24-48 hours after ingesting toxic. The diagnosis of toxic encephalopathy may be made after 24-48 hours and is characterized by: worsening coma, neurological signs advocating this dezinhibarea subcortical centers (psychomotor agitation, tonic-clonic contractions or anarchic movements, changes in sensitivity, autonomic signs (mydriasis, tachypnea , tachycardia, sweating).
The severity depends on the nature of toxic coma toxic. It is therefore important to identify it by anamnesis, clinical signs and laboratory batch. Specifically interested in the absorbed dose, time elapsed from the time of poisoning and the health of the body prior to the accident.
Coma overcome involves: - Abolition of reactivity: bilateral areflectica mydriasis, corneal reflex abolished; - Abolition of spontaneous breathing (after disconnection from the ventilator when carbon dioxide pressure is below 40 mmHg); - Loss of thermoregulatory; - Route electroencephalographic (EEG) is a linear path.
Treatment - general attitudes
The objectives of therapy in toxic coma if: ventilatory and cardiovascular stability (ABC), favoring the elimination of toxic complications and treatment. Ventilatory and cardiovascular stability provides: - Rest digestive gastric tube drainage; - Safety position: head bent back and right side facing, pipe Guedel (not swallow the tongue); - Suction secretions from the lower pharynx. Oxygen consists of: - Assisted ventilation or tracheotomy, if necessary; - Monitor blood pressure (BP), ECG - Hypovolaemia correction is done by: plasmexpander, vasoactive amines, dopamine is administered 5-10 mg / kg / min (1 f 10 ml Dopamine is 50. 000 mg), 1 vial + 40 ml glucose 5% (1 ml are1. 000 g) - Correction of acidosis and electrolyte rebalancing.
Treatment complications consisted of: - Avoid pressure sores; - Avoidance of corneal ulcers by: compresses with saline or eyewash instilatii repeated; - Hyperthermia treatment; - Treatment of seizures by administration of diazepam is 0, 3-0, 5 mg / kg intra-venous; - Treatment of rhythm disorders and cardiac arrest by maneuvers and specific medication.
Fostering is very important to eliminate toxic. This requires removing toxic from the gate, and after ingestion.
Removing toxic to the entrance gate is made depending on the location acestiua. If the gate is represented by the ocular mucosa and skin is envisaged washing thoroughly with plain water or warm saline. Toxicant located in the head hair can be removed by trimming and washing thoroughly with soap and water; situation commonly found in organophosphorus poisoning. If the respiratory mucosa is toxic gate has to be removed from the patient's environment, the release of the airways, oxygen therapy, when needed intubation and ventilation is assisted. If the digestive mucosa is toxic gate is gastric lavage with weak acids (acetic acid 1%) in the first hour after ingestion of caustic alkaline chemicals and corrosive acid ingestion in water is administered albumin.
To remove toxic ingested using several methods. First is provoaza vomiting. It is effective only during the first hour after ingestion. Depending on where you apply this method will be different dosage. At home the administration is plain water to dilute the toxic agent and causing vomiting. Pharyngeal excitation is made with a finger or blunt object; important is not to produce pharyngeal lesions. At the hospital the child is given Ypeca solution, if it has less than 1 year are given a dose of 5 ml, between 1-12 years if it is given a dose of 10-15 ml and a child less than 12 years and is given a dose of 30 ml. Dilute with water, fruit juice for 5-10 times. Vomiting occurring after more than 20 minutes. Maneuver can be repeated after 25-30 minutes if vomiting has not occurred. The child will be assisted by nurses or doctors and parents.
Gastric lavage is to accommodate the removal of toxins that are still in the stomach and limit absorption. The method is not useful: inhalation hypnotic benzodiazepines. Instead it is useful in poisoning with tricyclic antidepressants, antiarrhythmics, barbiturates, digital theophylline. Gastric lavage can be done in these cases even 6 hours after ingestion. It is important that these precautions be taken in case of normal swallowing, normal hemodynamics and normal respiratory function. If contraindications are poisoning with caustic substances, oils, wines, when installing coma (lavage should be made only after oro-tracheal intubation), collapse, ileus, strychnine poisoning, in case of seizures, swallowing reflex pierederea ( danger of false paths, inhalations).
Manage quantity of liquid is to be 150-200 ml. Repeat until the clarification of lavage fluid, without exceeding 2-3l in 10 to 12 passages. Before removing the probe will be given activated charcoal officinal, for a child less than 10 kg are given 10-20g, a child is given 10 to 15 kg and 20 g and 15 to 20 kg for a child is given a quantity of 30 g.
There are some particular situations, administration of antidotes in place of activated carbon: Nacetil cysteine in paracetamol poisoning, the dose is 140 mg / kg; Sodium thiosulfate, the dose is 2-4g and having the effect of neutralizing the action of sodium hypochlorite or potassium cholestyramine at a dose of 1-4 g is administered digitalis poisoning theophylline, tricyclic antidepressants, 2-5% magnesium sulfate solution is given in quantities of 100-200 ml in lead poisoning.
The administration of purgatives At the end of the stomach is administered spalaturii classic sodium or magnesium sulfate 2-3 g / year of age. Efficiency is low. Do not use if time from ingestion is more toxic than an hour.
Removal from circulation is toxic to the airway intubation and assisted ventilation for toxic volatile alcohols, benzene, ketones, chloroform, carbon monoxide. It monitors oxigenulu pressure (pO2), carbon dioxide pressure (PCO2) because there is danger of respiratory alkalosis. Another method is to remove toxic by the kidneys, is done by osmotic diuresis with mannitol concentration 10%, 10% serum glucose and electrolytes. Contains alkaline osmotic diuresis third mannitol 10%, 1 / 3 Na bicarbonate 14 ‰, one third the amount of liquid glucose 10% total is 2-3 times higher than physiological. These methods are listed in barbiturate poisoning, carbamate, phenothiazines.
Antagonism of circulating toxic antidote or therapy is based on several mechanisms. A first mechanism is the formation of a compound toxic inert. For example Desferal is used in iron poisoning, D-penicillamine in lead poisoning (Pb), copper (Cu) and EDTA in lead poisoning (Pb), mercury (Hg), iron (Fe). Another mechanism is based on the fact that they accelerate detoxification or inhibit aggressive metabolite synthesis. For example, N-acetylcysteine inhibits the formation of para-qinoniminei responsible for liver damage. A last mechanism has the effect of moving the sites of toxic action: naloxone for opiates, benzodiazepines Flumazenil.
Treatment consists of extrarenal hemodialysis. Indications for this method are only small-volume distribution toxins, low molecular weight. It also corrects and electrolyte disorders and acidobazice. Extrarenal purification and provides peritoneal dialysis. This is indicated especially in infants, but is less efficient than hemodialysis. They are also hemoperfuzii activated charcoal column by interposing a circuit activated charcoal cartridge. Method is used as therapy and plasmapheresis, and exchange transfusion used especially in new-born
The indications above mentioned methods call if poisoning with barbiturates, tranquilizers (diphenylhydantoin, primidone, Meprobamat, Codeine, chloral hydrate), alcohols (ethanol, methanol, ethylene glycol), Digoxin, cyclophosphamide, Methotrexate, hydrazide, Acetaminophen, Theophylline, Amanita faloides, Hexaclorura benzene, tricyclic antidepressants, toxic halogen (bromides, chlorides, iodides), various toxic (aniline, thiocyanate, opiates, quinine).
Specific antidotes for various types of poisoning are: - Is the antidote for anticholinergic physostigmine dose de1-2 mg intra-venous; - Tricyclic antidepressants have the antidote sodium bicarbonate (Na), administered in doses of 1-2 mg / kg intra-venous; - Betablocantii antidote glucagon are administered in doses of 5-10 mg intra-venous; - Ethylene glycol (antifreeze) is treated with an antidote called ethyl alcohol 10% administered by the intra-venous dose of 10 mg / kg; - Isoniazid antidote is vitamin B6; - Heavy metals such as mercury (Hg), gold (Au), nickel (Ni), lead (Pb) were taken orally as an antidote Dimercaprol muscle in a dose of 3 mg / kg every 4-6 hours; - Methemoglobinizante have the antidote methylene blue in doses of 1 mg / kg ADMINISTRATIVE vitamin C in the amount of 1 g intra-venous; - Paracetamol Nacetilcisteina antidote is administered by intra-venous or per-orally at a dose of 150mg/kg; - Parasimpaticomimetice antidote atropine are administered by intra-venous, in doses of 0, 05mg/kg.