Escolar Documentos
Profissional Documentos
Cultura Documentos
What is a Poison?
All substances are poisons;
there is none that is not a poison.
The right dose
differentiates a poison and a remedy.
Paracelsus (1493-1541)
02/10/17 IRD RS. Saiful Anwar Malang
The study of the adverse effects of a
toxicant on living organisms
Adverse effects
any change from an organisms normal state
dependent upon the concentration of active compound
at the target site for a sufficient time.
Toxicant (Poison)
any agent capable of producing a deleterious response
in a biological system
Living organism
a sac of water with target sites, storage depots and
enzymes
kontrol.
Hospital
- Personal oleh Yan-med terkait.
- Massal Yan-med terkait dan Din-kes.
1. Remove clothing quickly and seal in plastic impervious bags (save for
authorities). Strongly recommended even if exposure only to vapor or
aerosol agent.
2. Wash skin and shampoo with hypoallergenic liquid soap and copious tepid
water in sequential steps of rinse, soap, rinse, wait one minute, then final
additional rinse (20 minutes).
3. Latent response from cyanide or pulmonary agents do not require
decontamination.
4. Decontamination waste water may require special collection or treatment.
(Discuss with local water authorities; notify local water
authorities at the time of an event.)
5. Pure metals and strong corrosives require dry decontamination (i.e., gentle
brushing or vacuuming of larger particles) before water is
applied.
6. Clean and decontaminate the healthcare facility according to the specific
agent involved.
DEFINITIONS AND ASSUMPTIONS
First responder
Traditionally fire/EMS/Hazmat/law enforcement
Typically act at the site of a release (incident)
First receivers
Typically include personnel in the following roles:
Clinicians and other hospital staff that have a role in
receiving and treating contaminated patients
(decontamination, triage, medical treatment, and
security)
Hospital is distant from the incident
Thus the exposure of first receivers is limited to the
amount of contaminate on the victims, their clothing
and personal effects
Assumptions
Transport of victims from the scene
Decontaminated in the field to what extent?
Serious patients will be transported after the masses
arrive at the hospitals
Most Common Caused :
Accidentally during the manufacture
Industrial accidents
Tanker truck accident
Terrorist or military attack
Train derailments
Transportation
Storage
Deployment
Bahan Berbahaya
Hazzardeus Material
Biological Agents Chemical Agents
Airway
Breathing
Circulation
ANAMNESA :
- BAGAIMANA RACUN MASUK TUBUH :
- JUMLAH RACUN YANG MASUK.
- SUDAH BERAPA LAMA KONTAK.
- PERTOLONGAN PERTAMA YANG SUDAH DIBERIKAN.
- PROFIL PSYKOLOGI PENDERITA.
- GEJALA YANG TELAH DIALAMI PENDERITA.
PERLINDUNGAN PENOLONG.
LATEX GLOVE , PASTIC GOGLE, MASKER, SCORT.
. PROSEDURE :
- PINDAHKAN KORBAN DARI TKP.
- SEMPROT/CUCI MATA DAN SELURUH TUBUH DENGAN AIR
BERSIH SELAMA 2 5 MENIT.
- UNTUK MATA DITERUSKAN SAMPAI 10 15 MENIT.
- SEMUA PAKAIAN HARUS DILEPAS DAN SELURUH PERMUKAAN
KULIT HARUS DICUCI DENGAN SABUN SELAMA 10 15 MENIT.
- JIKA SUDAH ADAD LEPUHAN KULIT/BLISTER, DITABURI DENGAN
FULLERS EARTH / ATTAPULGITTE, BILAS DENGAN AIR 10 MENIT.
- JIKA TANGAN PX IKUT TERKONTAMINASI , KUKU AGAR DISIKAT
SECARA HALUS.
- JIKA PROSEDUR DIATAS SELESAI , BERI PAKAIAN KERING.
.
Pre-Hospital Phase
Warm Zone Hospital Phase
Cold Zone
First
Aid Hospital
Post
Decontamination
Emergency Dept
P1
Decontamination
Hospital Triage
Hot Zone
Triage
P2 Evac
P3
Wind
8 hrs
Total
Incident Commander /Safety/
24 hrs Technical Reference
12 hrs
Total First Responder-Operations employees expected to
16 hrs take defensive actions and conduct decontamination
4
hours First Responder Awareness- those employees that may encounter a
hazardous materials emergency and/or conduct directed self-decon.
Mustard Skin
Erythema 2-24 hours
Small Vesicles may Coalesce to
form Bulla
High Dose Exposure Central
Zone of Coagulation necrosis
PERLINDUNGAN PENOLONG.
LATEX GLOVE , PASTIC GOGLE, MASKER, SCORT.
. PROSEDURE :
- PINDAHKAN KORBAN DARI TKP (source of agent).
- BERI OKSIGEN 100% , HIGH FLOW.
- JIKA PERLU DILAKUKAN BRONCO-ALVEOLAR
LAVAGE.
METODA DEKONTAMINASI :
DILUSI/ PENGENCERAN.
1. AIR ADALAH PENGENCER YANG TERBAIK
2. DOSIS YANG DIANJURKAN 100 200 ML PADA ANAK DAN
200 400 ML PADA DWS.
3. SUSU UNTUK BAHAN KAUSTIK ATAU IRRITANT .
02/10/17
KEMBALI SAMPAI JERNIH.
IRD RS. Saiful Anwar Malang
8. MASUKAN 50 100 MG CHARCOAL AKTIF, SEBELUM
MENGELUARKAN NGT.
CHARCOAL AKTIF.
BAHAN PENYERAP AKTIP UNTUK BEBERAPA RACUN
SEPERTI :
Acetaminophen
Aliphatic alcohols
(3) Amitryptylline (and other tricyclic antidepressants)
Antipyrines
Arsenic
Aspirin
Atropine
Chlorpheniramine (and related antihistamines)
Chlorpromazine (and other phenothiazines)
Dextro-amphetamine
Digoxin
Glutethimide
Imipramide
DOSIS :
DWS : DOS 1 = 30-50Gr DALAM 100 200 ML AIR PERORAL.
ULANGAN = 15 25 Gr / 50ML AIR SETIAP2- 4 JAM
SAMPAI 24 JAM
KONTRA INDIKASI
1. DIARE AKTIF.
2. OBSTRUKSI USUS/ILEUS.
3. HYPOVOLUMIA.
4. INFANT.
5. REANL FAILURE DAN ABDOMINAL TRAUMA.
02/10/17 IRD RS. Saiful Anwar Malang
HAL YANG PERLU DIPERHATIKAN SEBELUM PEMAKAIAN
KATARTIK :
1. TIDAK BOLEH DIGUNAKAN PADA USIA ANAK YANG COBA-COBA
2. PADA ANAK YANG MEMGGUNAKAN PREPARAT PHOSPO-
SODA/SODA KUE TIDAK BOLEH MENGUNAKAN KATARTIK.
3. KATATIK DENGAN BAHAN DASAR MINYAK SUPAYA DIHINDARI ---
ASPIRASI DAN MENGGALAKAN PEYERAPAN RACUN.
4. PADA ANAK AGAR DIPANTAU STATUS CAIRAN DAN ELEKTROLIT
TERUTAMA PAD PENGUNA SORBITOL.
5. BAHAN KATARTIK DENGAN KANDUNGAN MAGNESIUM
SEBAIKNYA DI HINDARI UNTUK MENGULANG.