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Botulism Protocol - الفسيخ

Botulism Protocol - الفسيخ

BOTULISM PROTOCOL

1. General Characteristics & Pathophysiology

Mechanism of Action

  • Once toxin absorbed, it spreads via blood and the lymphatic system to peripheral Ach synapses.
  • Irreversibly binds to cholinergic nerve terminals and prevent release of Ach from motor and autonomic nerve terminals resulting in flaccid paralysis and autonomic dysfunction.
  • Toxin cannot cross BBB.

2. Clinical Presentation

History: History of meal ingestion (canned food, raw fish).

Clinical Picture

  • Specific Symptoms: Visual disturbances, dysarthria, dysphagia, and dry mouth are the 4 most specific neurologic symptoms.
  • General Symptoms: Nausea, vomiting, sore throat, and abdominal discomfort.
  • Timing: Neurologic symptoms delayed to 12-36 hrs. May be up to 8 days.
  • Detailed Signs:
    • Diplopia, ptosis, ophthalmopleagia, dysarthria, dysphagia, dysphonia, by progressive symmetric descending paralysis.
    • Pupils dilated and unreactive or normal.
    • Constipation and ileus may occur.
    • Profound weakness involving the respiratory muscles is the cause respiratory failure and death.
Note: pt is conscious, no sensory manifestations, no fever.
Therapeutic injections of toxin may result in transient adverse effects, but serious sequelae are rare.

3. ER Management Protocol

Assessment: History of meal ingestion.

Unstable Patient

Action: ABC (Airway, Breathing, Circulation).

ICU ADMISSION

Stable Patient

Action: Gastric lavage within 4 hours of ingestion + AC.

Then Assess for Symptoms:

1. NO neurological symptoms (Asymptomatic):
  • Ward admission for 24 h.
  • Give AC except if ilieus.
  • Observe: Vital data, intestinal sounds, neurological, Anticholinergic.
2. WITH Neurological symptoms:

(Cranial n palsy, skeletal ms paralysis, Anticholinergic/Ileus/Constipation)

ICU ADMISSION

4. ICU Management & Treatment

Supportive Care

  • Support respiration, Fluids, ABGs, Electrolytes, RFT.
  • Treatment of infant botulism involves supportive care only.

Anti Botulinum Toxin

  • Most effective when given within 24 h, but should be given at any time.
  • Dose and Infusion rate: As recommended by the ministry of health and inclusion paper.
  • Can be given in pregnancy.

INDICATION OF MECHANICAL VENTILATION:

  • Progressive weakness
  • RR < 10
  • Po2 < 60
  • 02 sat < 90
  • PCO2 > 60
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