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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



Ethyl alcohol a cns depressant drug
Ethyl AlcoholA CNS Depressant Drug


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


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


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! intake:

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 intake:

  • Opium

  • Opium derivatives

  • Synthetic compounds that produce opium-like effects


Narcotics1
Narcotics intake:

  • Percodan

  • Codeine

  • Darvon

  • Talwin

  • Opium

  • Heroin

  • Morphine

  • Demerol

  • Dilaudid


Narcotics2
Narcotics intake:

  • Medical Uses

    • analgesics

    • anti-diarrheal agents

    • cough suppressants


Narcotics3
Narcotics intake:

  • Overdose

    • Coma

    • Respiratory depression

    • Constricted (pin-point) pupils


Narcotics4
Narcotics intake:

  • Withdrawal

    • Agitation

    • Anxiety

    • Abdominal pain

    • Dilated pupils

  • Sweating

  • Chills

  • Joint pains

  • Goose flesh

Resembles severe influenza

Not a life-threat


Barbiturates

Nembutal intake:

Seconal

Pentobarbital

Amytal

Tuinal

Phenobarbital

Barbiturates


Barbiturates1

Induce sleepiness, state similar to EtOH intoxication intake:

Medical uses

Anesthetics

Sedative

Hypnotics

Barbiturates


Barbiturates2
Barbiturates intake:

Overdose

Coma

Respiratory depression

Shock

Extremely dangerous in combination with EtOH


Barbiturates3
Barbiturates intake:

Withdrawal

Resembles EtOH withdrawal (DTs)

Extremely dangerous


Barbiturate like non barbiturates
Barbiturate-like Non-barbiturates intake:

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 intake:

Low doses relieve anxiety, produce muscle relaxation

High doses produce barbiturate-like effects

Tranquilizers


Tranquilizers1

Overdose: intake:

Unlikely to cause respiratory arrest alone

Extremely dangerous with EtOH

Withdrawal

Resembles EtOH withdrawal

Extremely dangerous

Tranquilizers


Cns stimulants amphetamines
CNS Stimulants: Amphetamines intake:

  • Dexedrine, Benzedrine, Methyl amphetamine

  • Relieve fatigue, promote euphoria, reduce appetite


Cns stimulants amphetamines1
CNS Stimulants: Amphetamines intake:

  • Overdose

    • Restlessness, paranoia

    • Tachycardia

    • Hypertension CVA, Heart failure

    • Hyperthermia Heat stroke

  • Withdrawal

    • Lethargy

    • Depression


Cns stimulants cocaine

Stronger stimulant effects than amphetamines intake:

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

CNS Stimulants: Cocaine


Cns stimulants cocaine1

“Snorting” can destroy nasal septum, cause massive nosebleed

Withdrawal:

lethargy

depression

CNS Stimulants: Cocaine


Hallucinogens

LSD, psilocybin, peyote, mescaline, DMT, MDMA nosebleed

Enhance perception

Wrong setting may induce “bad trips” with extreme anxiety

True toxic overdose rare

Hallucinogens


Phencyclidine
Phencyclidine nosebleed

  • 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 nosebleed

Inhalation produces state similar to EtOH intoxication

Patient may asphyxiate if consciousness lost while “sniffing”

Solvents


Solvents1

Increase risk of arrhythmias nosebleed

May cause liver damage, bone marrow depression

Chronic abuse causes CNS damage - paranoia, violent behavior

Solvents