PH9.2 | PH9.2 | Common Toxicology Emergencies — SDL Guide — Summary & Reflection

KEY TAKEAWAYS

Toxidrome recognition is the first step: cholinergic (SLUDGE + miosis + fasciculations — OP poisoning), anticholinergic (mydriasis + dry + hot + confused), opioid (miosis + respiratory depression + coma), sedative-hypnotic (CNS depression + normal pupils). Management hierarchy: ABCDE → antidote → decontamination → enhanced elimination. Key antidote-poison pairs: Paracetamol → NAC (replenishes glutathione; most effective <10 h; Rumack-Matthew nomogram guides treatment); Opioids → Naloxone (μ-receptor competitive antagonist; repeat dosing needed as its half-life < opioid); Benzodiazepines → Flumazenil (use with caution — avoid in TCA co-ingestion and in benzodiazepine-dependent seizure patients); Organophosphates → Atropine (muscarinic effects only, endpoint = dry secretions) + Pralidoxime (reactivates AChE before aging; treats nicotinic effects too). Bee/wasp anaphylaxis → Epinephrine 0.5 mg IM. Indian red scorpion → Prazosin (α-1 blocker for catecholamine storm). Snake bite → Polyvalent ASV (diagnose VICC with 20WBCT; repeat ASV if 20WBCT positive at 6 hours). Dog bite Cat III → Wound wash + ARV + RIG.

REFLECT

Imagine you are the medical officer of a primary health centre in a rural district during the harvest season. In one shift, you see: a farmer with organophosphate poisoning, a child bitten by a suspected krait, and a teenager who took paracetamol tablets in a suicidal attempt 6 hours ago. Reflect on: Which of these three cases is the most time-sensitive, and why? Which would you manage first? What resources (antidotes, equipment) would you need at your PHC to handle all three? What system-level changes to rural healthcare would reduce the mortality from each of these poisoning categories? This exercise connects pharmacological knowledge to real-world clinical decision-making.