General Measures in the Management of Acute Pesticide Poisoning

I. Emergency stabilization

As in any other serious medical emergency, life-saving measures should take priority in poisoning cases.

Thus, in a suspected or frank case of poisoning, the management is directed towards the immediate life-threatening problems of airway obstruction, breathing difficulties, circulatory inadequacy, drug-induced CNS depression, and electrolyte or metabolic abnormalities (ABCDE).	ABCs of Life Support   Maintain adequate airway   Provide adequate oxygenation/ventilation   Maintain adequate circulation   Treat convulsions   Correct metabolic abnormalities   Treat coma
A. Maintain adequate airway
All patients must be assessed for airway patency. Patients who are awake are likely to have intact airways. However, decreasing sensorium due to worsening intoxication may compromise airway patency. In patients with decreased sensorium, the gag or cough reflex may give an indirect estimate of the patient’s ability to keep the airway clear. In the event of an obstructed airway, the patient must be placed in supine position. The chin-lift and jaw-thrust maneuvers may be done to position the tongue away from the airway. Remove any foreign body (dentures, oropharyngeal secretions) that may obstruct the airway. Rule out cervical fracture before attempting endotracheal intubation. In cases of respiratory insufficiency, loss of consciousness, impaired or absent gag reflex and status epilepticus, endotracheal intubation should be done by trained or experienced personnel. Once a tube is inserted, administer humidified air to prevent drying, crusting and sloughing of the tracheal mucosa. Do bronchial toilet on a regular basis, depending on the volume of secretions.