Anaesthesiology and intensive care : Topic 1: Acute poisonings; Topic 2: Comatose states

Abstract

Poisoning is a worldwide problem that consumes substantial healthcare resources and causes many premature deaths. The burden of serious poisoning is carried by the developing world1; however, poisoning related morbidity and mortality are also a significant public health concern in the developed world. Unintentional poisoning deaths in the United States are increasing, especially as a result of prescription analgesics. This increase has been ascribed to increasing prescription rates and aging of the baby-boom population. Prevention is the key to reducing unintentional poisoning deaths. Pharmacists can ensure that medications are labeled correctly, anticipate potential drug interactions, and educate patients to use medications safely. Parents have the responsibility to ensure that poisons are placed in childproof, labeled containers stored in adult only accessible nonfood storage areas to reduce pediatric exposures. Teachers and healthcare providers can provide age-appropriate education to children about the dangers of poisons. After an exposure, poison control centers staffed by highly trained individuals can provide customized advice to healthcare providers and the public. Poison control centers also participate in prevention, education, and toxico-surveillance activities. Rapid development of industry, in particular chemical and pharmacological, in the last decades resulted in considerable expansion of domestic chemical agents assortment with potentially toxic properties. This also leaded to contamination of environment, to spreaded of self-treatment with the use of drastic medicine, and to increasing of suicidal attempts incidence and elsewhere. Therefore the quantity of the acute exogenous poisonings increases progressively, and number of such hospitalized patients is one in a thousand of population per year. Taking into account the enormous variety of poison substances, extremely important for a doctor is ability to determine character of prevailing toxic influence on an organism (neurotoxic, cardiotoxic, hepatotoxic, nephrotoxic, hemotoxic and other) and as far as possible to perform organ protective intensive therapy. Such measures include normalization of hemodynamics, hemocoagulation, breathing, and treatment of brain edema. The rapid correction of leading syndrome in poisoning patients is often preceded to the detoxication, because its determine safety of detoxication procedures. The contact of organism with a poison results in stimulation of natural detoxification. The role of a doctor here consists in knowledge about features of poison contact with an organism, routes of its transformation and elimination, stimulation and replacement methods of organs detoxification function.