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Poisoning - PowerPoint PPT Presentation

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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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Temple College

EMS Professions


  • 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. . .

  • 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


  • Increasing amounts of drug needed to produce same effects

  • Tolerance contributes to addiction by keeping user “chasing the last high”


  • 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


  • 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



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 intake:

  • Opium

  • Opium derivatives

  • Synthetic compounds that produce opium-like effects

Narcotics intake:

  • Percodan

  • Codeine

  • Darvon

  • Talwin

  • Opium

  • Heroin

  • Morphine

  • Demerol

  • Dilaudid

Narcotics intake:

  • Medical Uses

    • analgesics

    • anti-diarrheal agents

    • cough suppressants

Narcotics intake:

  • Overdose

    • Coma

    • Respiratory depression

    • Constricted (pin-point) pupils

Narcotics intake:

  • Withdrawal

    • Agitation

    • Anxiety

    • Abdominal pain

    • Dilated pupils

  • Sweating

  • Chills

  • Joint pains

  • Goose flesh

Resembles severe influenza

Not a life-threat


Nembutal intake:








Induce sleepiness, state similar to EtOH intoxication intake:

Medical uses





Barbiturates intake:



Respiratory depression


Extremely dangerous in combination with EtOH

Barbiturates intake:


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


Valium, Librium, Miltown, Equanil, Tranxene intake:

Low doses relieve anxiety, produce muscle relaxation

High doses produce barbiturate-like effects



Overdose: intake:

Unlikely to cause respiratory arrest alone

Extremely dangerous with EtOH


Resembles EtOH withdrawal

Extremely dangerous


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




CNS Stimulants: Cocaine


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

Enhance perception

Wrong setting may induce “bad trips” with extreme anxiety

True toxic overdose rare


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


Glue, paint, gas, light fluid, toluene nosebleed

Inhalation produces state similar to EtOH intoxication

Patient may asphyxiate if consciousness lost while “sniffing”



Increase risk of arrhythmias nosebleed

May cause liver damage, bone marrow depression

Chronic abuse causes CNS damage - paranoia, violent behavior