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Poisoning/Alcohol/Overdose

Adapted From Temple College EMS Professions. Poisoning/Alcohol/Overdose. 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)

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Poisoning/Alcohol/Overdose

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  1. Adapted From Temple College EMS Professions Poisoning/Alcohol/Overdose

  2. Poisons • Substance which when introduced into body in relatively small amounts causes in structural damage or functional disturbances

  3. 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

  4. Treat Patient, Not Poison • Proper support of ABCs is first step in management • Contact with Poison Control Center • Priority action plan • Symptomatic treatments • Time management

  5. Try to determine: • What? • How much? • How long ago? • What has already been done? • Psychiatric history? • Underlying illness?

  6. When in doubt. . . • Assume containers were full • Entire contents were ingested • Patient may not be telling you the truth

  7. If several patients involved. . . • Assume each ingested entire container contents • Triage • Additional resources

  8. Always. . . • Bring sample of material if possible • Save for analysis, if patient vomits

  9. Poisoning Management • Based on route of entry • Ingested • Absorbed • Inhaled • Injected

  10. Ingested Poisons • Prevent absorption of toxin from GI tract into bloodstream • Positioning • Rapid Transport to definitive treatment center

  11. 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!

  12. Inhaled Poisons • Remove patient from exposure • Maximize oxygenation, ventilation CAUTION Don’t accidentally expose yourself!

  13. 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]

  14. Drug Abuse/Overdose

  15. Substance Abuse • Self administration of a substance in a manner not in accord with approved medical or social practices

  16. Substance Abuse • Psychological dependence • Physical dependence • Compulsive drug use • Tolerance • Addiction

  17. Psychological Dependence • Habituation • Substance needed to support user’s sense of well-being

  18. Physical Dependence • Substance must be present in body to avoid physical symptoms (withdrawal)

  19. Compulsive Drug Use • Use of drug and rituals/culture associated with its use become an overwhelming desire

  20. Tolerance • Increasing amounts of drug needed to produce same effects • Tolerance contributes to addiction by keeping user “chasing the last high”

  21. 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

  22. Ethyl Alcohol (EtOH)

  23. Ethyl AlcoholA CNS Depressant Drug

  24. Ethanol Intoxication Signs • Breath odor • Swaying, unsteadiness • Slurred speech • Nausea, vomiting • Flushed face • Drowsiness • Violent, erratic behavior

  25. Ethanol • Clouds signs, symptoms • Complicates assessment • Head trauma, diabetes, drug toxicity, CNS infection can mimic EtOH intoxication and vice versa

  26. Patient is NEVER “just drunk” until all other possibilities are excluded

  27. 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

  28. 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

  29. Narcotics • Opium • Opium derivatives • Synthetic compounds that produce opium-like effects

  30. Narcotics • Percodan • Codeine • Darvon • Talwin • Opium • Heroin • Morphine • Demerol • Dilaudid

  31. Narcotics • Medical Uses • analgesics • anti-diarrheal agents • cough suppressants

  32. Narcotics • Overdose • Coma • Respiratory depression • Constricted (pin-point) pupils

  33. Narcotics • Withdrawal • Agitation • Anxiety • Abdominal pain • Dilated pupils • Sweating • Chills • Joint pains • Goose flesh Resembles severe influenza Not a life-threat

  34. Nembutal Seconal Pentobarbital Amytal Tuinal Phenobarbital Barbiturates

  35. Induce sleepiness, state similar to EtOH intoxication Medical uses Anesthetics Sedative Hypnotics Barbiturates

  36. Barbiturates Overdose Coma Respiratory depression Shock Extremely dangerous in combination with EtOH

  37. Barbiturates Withdrawal Resembles EtOH withdrawal (DTs) Extremely dangerous

  38. 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

  39. Valium, Librium, Miltown, Equanil, Tranxene Low doses relieve anxiety, produce muscle relaxation High doses produce barbiturate-like effects Tranquilizers

  40. Overdose: Unlikely to cause respiratory arrest alone Extremely dangerous with EtOH Withdrawal Resembles EtOH withdrawal Extremely dangerous Tranquilizers

  41. CNS Stimulants: Amphetamines • Dexedrine, Benzedrine, Methyl amphetamine • Relieve fatigue, promote euphoria, reduce appetite

  42. CNS Stimulants: Amphetamines • Overdose • Restlessness, paranoia • Tachycardia • Hypertension CVA, Heart failure • Hyperthermia Heat stroke • Withdrawal • Lethargy • Depression

  43. Stronger stimulant effects than amphetamines Can cause respiratory/cardiovascular failure, heat stroke, lethal arrhythmias CNS Stimulants: Cocaine

  44. “Snorting” can destroy nasal septum, cause massive nosebleed Airway issue Withdrawal: lethargy depression CNS Stimulants: Cocaine

  45. LSD, psilocybin, peyote, mescaline, DMT, MDMA Enhance perception Wrong setting may induce “bad trips” with extreme anxiety True toxic overdose rare Hallucinogens

  46. 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

  47. Glue, paint, gas, light fluid, toluene Inhalation produces state similar to EtOH intoxication Patient may asphyxiate if consciousness lost while “sniffing” Solvents

  48. Increase risk of arrhythmias May cause liver damage, bone marrow depression Chronic abuse causes CNS damage - paranoia, violent behavior Solvents

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