TOXICOLOGY - HANGING /STRANGULATION, PARAQUAT POISONING -DR NIKHILESH JAIN ( director &head ccm )

00:00:00 intro,hanging
00:15:00 paraquat poisoning

He explains that hanging is a type of strangulation injury caused by external mechanical force applied to the neck, resulting in decreased cerebral oxygen delivery. He discusses the terminology, physiology, and mechanisms involved in hanging injuries, including complete versus incomplete hanging, vascular injuries, cardiac dysrhythmias, and neurological consequences. Dr. Jain also mentions the mechanisms of pulmonary edema seen in these cases, such as neurogenic and post-obstructive causes. The summary focuses on the key points covered in the presentation, without going into excessive detail.
Hanging Survivors: Management and Complications
Nikhilesh discussed the potential complications and management of patients who have survived hanging. He highlighted the importance of early intubation and airway management, as well as the need for diagnostic imaging and testing. Nikhilesh also mentioned the potential for respiratory distress, mental status changes, and various physical examination findings such as ligature marks, abrasions, and laryngeal fractures. He emphasized the importance of considering poor prognostic variables such as prolonged hanging time, anoxic brain injury, and coexisting cervical spine injury. Dr. added that cardiac involvement and reperfusion injury should also be considered, and that vigilance is necessary even after stabilizing the patient. Both agreed on the importance of a thorough neurological examination and toxicology screening.
Paraquat Poisoning: Toxicity and Management
Nikhilesh discussed the toxicology and pharmacokinetics of paraquat poisoning, a rapidly acting, non-selective herbicide that can be fatal upon ingestion. He highlighted that organs with high blood flow, oxygen tension, and energy requirements, such as the lungs, heart, kidneys, and liver, are most impacted. Nikhilesh also explained that paraquat is highly polar and corrosive, and its absorption is rapid but incomplete. He noted that the elimination of paraquat is primarily through the kidneys, and its presence in high concentrations in lung, kidney, liver, and muscle tissues is due to active uptake by cell membrane transporters. Nikhilesh also discussed the historical points of interest, symptoms, and signs of poisoning, as well as the importance of monitoring blood tests, arterial blood gases, and chest imaging. He concluded by discussing the diagnostic tests for paraquat poisoning and the management of symptoms and signs of poisoning.
Paracetamol Poisoning Management Strategies
Nikhilesh discussed the management of paracetamol poisoning, emphasizing the importance of early intervention. He highlighted that hemoperfusion or hemodialysis can be beneficial if the patient reaches within 4 hours of poisoning, but most patients reach late, making this option unavailable. Nikhilesh also mentioned the use of supplemental oxygen, monitoring lactates and renal functions, and the potential use of dexamethasone for severe poisoning. He stressed the futility of treatment once systemic toxicity appears and the importance of supportive care rather than intensive care for patients with severe poisoning. Dr. added that charcoal hemoperfusion should be offered initially, and that lung transplant is not helpful due to the persistence of paracetamol levels. Both agreed that most patients present with acidosis, deranged liver function tests, and acute kidney injury, and that early intervention is crucial for better outcomes.

to consider using sodium dithionite test for qualitative assessment of paraquat poisoning severity when patients present early.
to consider early hemoperfusion for paraquat poisoning cases that present within 4 hours of ingestion.