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Poisoning. Temple College EMS Professions. Poisons. Substance which when introduced into body in relatively small amounts causes in structural damage or functional disturbances. Suspect with:. GI signs/symptoms (nausea, vomiting, diarrhea, pain) Altered LOC, seizures, unusual behavior

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poisoning

Poisoning

Temple College

EMS Professions

poisons
Poisons
  • Substance which when introduced into body in relatively small amounts causes in structural damage or functional disturbances
suspect with
Suspect with:
  • GI signs/symptoms (nausea, vomiting, diarrhea, pain)
  • Altered LOC, seizures, unusual behavior
  • Pupil changes, salivation, sweating, other signs/symptoms of disturbed autonomic nervous system function
  • Respiratory depression
  • Burns, blisters of lips, mucous membranes
  • Unusual breath odors
treat patient not poison
Treat Patient, Not Poison
  • Proper support of ABCs is first step in management
try to determine
Try to determine:
  • What?
  • How much?
  • How long ago?
  • What has already been done?
  • Psychiatric history?
  • Underlying illness?
when in doubt
When in doubt. . .
  • Assume containers were full
  • Entire contents were ingested
if several patients involved
If several patients involved. . .
  • Assume each ingested entire container contents
always
Always. . .
  • Bring sample of material if possible
  • Save for analysis, if patient vomits
  • Call poison center for advice on management
poisoning management
Poisoning Management
  • Based on route of entry
    • Ingested
    • Absorbed
    • Inhaled
    • Injected
ingested poisons
Ingested Poisons
  • Prevent absorption of toxin from GI tract into bloodstream
    • Activated charcoal
    • Syrup of Ipecac
activated charcoal

Activated Charcoal

Adsorbs toxin, prevents absorption from GI tract

activated charcoal1
Activated Charcoal
  • Names
    • SuperChar
    • InstaChar
    • Actidose
    • Liqui-Char
activated charcoal2
Activated Charcoal
  • Form
    • Premixed in water (slurry)
    • Usually bottle containing 12.5 gms
activated charcoal3
Activated Charcoal
  • Dosage
    • 1 gm/kg of patient body weight
    • Usual adult dose: 25 to 50 gms
    • Usual child dose: 12.5 to 25 gms
activated charcoal4
Activated Charcoal
  • Contraindications
    • Altered mental status
    • Inability to swallow
    • Ingestion of acids or alkalis
  • Does not bind
    • Alcohol
    • Petroleum products
    • Metals (iron)
activated charcoal5
Activated Charcoal
  • Side Effects
    • Nausea, vomiting
    • Black stools
activated charcoal6
Activated Charcoal
  • Administration
    • Shake container thoroughly
    • Use covered opaque container
    • Have patient drink through straw
    • If patient vomits dose may be repeated
syrup of ipecac
Syrup of Ipecac
  • Induces vomiting by irritating stomach and stimulating vomiting center in brainstem
  • Seldom used anymore
  • May be helpful if ingestion has occurred within last 30 minutes
syrup of ipecac1
Syrup of Ipecac
  • Dose
    • Children = 15 cc orally
    • Adults = 30 cc orally
  • Repeat once after 20 minutes as needed
  • Be sure patient has H20 in stomach
  • Should not be given at same time as activated charcoal
syrup of ipecac2
Syrup of Ipecac
  • Contraindications
    • Decreased level of consciousness
    • Seizing or has seized
    • Caustic poison (acids or alkalis)
    • Petroleum based products
absorbed poisons
Absorbed Poisons
  • Dry chemicals
    • dust skin, then
    • wash
  • Liquid chemicals
    • wash with large amounts of H20
    • avoid “neutralizing” agents

CAUTION Don’t accidentally expose yourself!

inhaled poisons
Inhaled Poisons
  • Remove patient from exposure
  • Maximize oxygenation, ventilation

CAUTION Don’t accidentally expose yourself!

injected poisons
Injected Poisons
  • Attempt to slow absorption
    • Venous constricting bands
    • Dependent position
    • Splinting of injected body part
    • Cold packs (+) [May worsen local injury by concentrating poison]
substance abuse
Substance Abuse
  • Self administration of a substance in a manner not in accord with approved medical or social practices
substance abuse1
Substance Abuse
  • Psychological dependence
  • Physical dependence
  • Compulsive drug use
  • Tolerance
  • Addiction
psychological dependence
Psychological Dependence
  • Habituation
  • Substance needed to support user’s sense of well-being
physical dependence
Physical Dependence
  • Substance must be present in body to avoid physical symptoms (withdrawal)
compulsive drug use
Compulsive Drug Use
  • Use of drug and rituals/culture associated with its use become an overwhelming desire
tolerance
Tolerance
  • Increasing amounts of drug needed to produce same effects
  • Tolerance contributes to addiction by keeping user “chasing the last high”
addiction
Addiction
  • Combination of psychological dependence, physical dependence, compulsive use, and tolerance
  • Patient becomes totally consumed with obtaining, using drug to exclusion of all other things
ethanol intoxication signs
Ethanol Intoxication Signs
  • Breath odor
  • Swaying, unsteadiness
  • Slurred speech
  • Nausea, vomiting
  • Flushed face
  • Drowsiness
  • Violent, erratic behavior
ethanol
Ethanol
  • Clouds signs, symptoms
  • Complicates assessment
  • Head trauma, diabetes, drug toxicity, CNS infection can mimic EtOH intoxication and vice versa
alcohol addicts
Experience alcohol withdrawal syndrome if they reduce intake:

Restlessness, tremulousness

Hallucinations

Seizures

Delirium tremens--all of above plus tachycardia, nausea, vomiting, hypertension, elevated body temperature

Alcohol Addicts
delirium tremens
Life threatening condition!

Occurs 1 days to 2 weeks after intake is decreased

5 to 15% mortality

Control airway, prevent aspiration, monitor for hypovolemia

Delirium Tremens
narcotics
Narcotics
  • Opium
  • Opium derivatives
  • Synthetic compounds that produce opium-like effects
narcotics1
Narcotics
  • Percodan
  • Codeine
  • Darvon
  • Talwin
  • Opium
  • Heroin
  • Morphine
  • Demerol
  • Dilaudid
narcotics2
Narcotics
  • Medical Uses
    • analgesics
    • anti-diarrheal agents
    • cough suppressants
narcotics3
Narcotics
  • Overdose
    • Coma
    • Respiratory depression
    • Constricted (pin-point) pupils
narcotics4
Narcotics
  • Withdrawal
    • Agitation
    • Anxiety
    • Abdominal pain
    • Dilated pupils
  • Sweating
  • Chills
  • Joint pains
  • Goose flesh

Resembles severe influenza

Not a life-threat

barbiturates
Nembutal

Seconal

Pentobarbital

Amytal

Tuinal

Phenobarbital

Barbiturates
barbiturates2
Barbiturates

Overdose

Coma

Respiratory depression

Shock

Extremely dangerous in combination with EtOH

barbiturates3
Barbiturates

Withdrawal

Resembles EtOH withdrawal (DTs)

Extremely dangerous

barbiturate like non barbiturates
Barbiturate-like Non-barbiturates

Doriden, Placidyl, Quaalude, Methyprylon

Effects similar to barbiturates

Overdose can cause sudden, very prolonged respiratory arrest

Withdrawal resembles ETOH; extremely dangerous

tranquilizers
Valium, Librium, Miltown, Equanil, Tranxene

Low doses relieve anxiety, produce muscle relaxation

High doses produce barbiturate-like effects

Tranquilizers
tranquilizers1
Overdose:

Unlikely to cause respiratory arrest alone

Extremely dangerous with EtOH

Withdrawal

Resembles EtOH withdrawal

Extremely dangerous

Tranquilizers
cns stimulants amphetamines
CNS Stimulants: Amphetamines
  • Dexedrine, Benzedrine, Methyl amphetamine
  • Relieve fatigue, promote euphoria, reduce appetite
cns stimulants amphetamines1
CNS Stimulants: Amphetamines
  • Overdose
    • Restlessness, paranoia
    • Tachycardia
    • Hypertension CVA, Heart failure
    • Hyperthermia Heat stroke
  • Withdrawal
    • Lethargy
    • Depression
cns stimulants cocaine
Stronger stimulant effects than amphetamines

Can cause respiratory/cardiovascular failure, heat stroke, lethal arrhythmias

CNS Stimulants: Cocaine
hallucinogens
LSD, psilocybin, peyote, mescaline, DMT, MDMA

Enhance perception

Wrong setting may induce “bad trips” with extreme anxiety

True toxic overdose rare

Hallucinogens
phencyclidine
Phencyclidine
  • PCP, angel dust
  • Produces bizarre, violent behavior
  • Reduces pain sensation
  • Patients may be capable of feats of extreme strength
  • Keep patient in quiet environment, minimize stimulatin
solvents
Glue, paint, gas, light fluid, toluene

Inhalation produces state similar to EtOH intoxication

Patient may asphyxiate if consciousness lost while “sniffing”

Solvents
solvents1
Increase risk of arrhythmias

May cause liver damage, bone marrow depression

Chronic abuse causes CNS damage - paranoia, violent behavior

Solvents
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