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Toxicology

Toxicology. Madison County EMD Andrew Scordato EMT-P. Toxic Exposure. 10% of ED visits and EMS responses involve toxic exposures. 70% of accidental poisonings occur in children under 6 years old. Drug Abuse In 2010 22.6 million 4.6 million ED visits 46% involved abuse

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Toxicology

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  1. Toxicology Madison County EMD Andrew Scordato EMT-P

  2. Toxic Exposure • 10% of ED visits and EMS responses involve toxic exposures. • 70% of accidental poisonings occur in children under 6 years old. • Drug Abuse • In 2010 22.6 million • 4.6 million ED visits 46% involved abuse • Mortality-100,000- 1 in 4 • Cost ½ trillion dollars • Common Rx’s=Alcohol, Stimulants, Hallucinogens, Prescription medications

  3. Routes of Exposure • Inhalation • Example-Huffing-paint, gasoline, nitrous oxide, Carbon monoxide, ammonia, chlorine, Tear gas, Freon, methyl chloride, Carbon tetrachloride • A&P- Capillary exchange • Assessment-Respiratory, CNS, Cardiac, • Management

  4. Routes • Ingestion • Examples-prescription medications,Household/Cleaning agents , Petroleum-based agents, Cosmetics, plants, or foods • A&P- absorption in stomach and small intestine • Assessment- What, When and quantity, Physical exam? • Management-ABC use AEIOUTIPS

  5. Routes • Surface Absorption • Examples-Poison ivy, Organophosphates, Fentanyl patches other pain patches • A&P-Drug and patient dependent • Assessment-Respiratory, Neurologic • Management-Removal of drug

  6. Routes • Injection • Examples-IV drug abuse-Heroin/Steroid users • A&P-Intravenous VS. Intramuscular • Assessment-Physical findings- Sites? • Management-ABC treat with Antidote if possible

  7. Poison Control Centers Provide detailed information 24hr staffed Id pills and toxicity Effects

  8. Inhaled Toxins

  9. Ingested toxins Alcohol A lot of other drugs which we will cover shortly

  10. Surface absoredposions

  11. Specific Drugs

  12. Opiates Herion

  13. Definitions Drug abuse-nontherapeutic Overdose-in excess Addiction-overwhelming need Tolerance-larger doses Withdrawal-psychological/physical effects

  14. Why? Pleasurable Social Anxiety Performance enhancing Curiosity

  15. Specific Drugs • Hallucinogens • Mind altering/CNS • Common agents-LSD, PCP, Mescaline • Example-Jimson Weed • Anticholinergic effects • Atropine • Effects 24-48 hours • Assessment-Hallucinations, Hyperthermia, Photophobia • Tx-ABC, Rapid transport, beware of Seizures and Violent Behavior

  16. Specific • Sympathomimetic • Examples-Cocaine, Bath Salts, Khat • Effects-extreme sympathetic arousal • Assessment-Cocaine=Chest pain/Bath Salts=Delusions, Paranoia/Khat=Anxious-----Excited Delirium? • Treatment-Safety, Sedation?, Calm

  17. Bath Salts Video http://www.youtube.com/watch?v=bKbTbRqXVFg

  18. Specific • Amphetamines • Example-Crystal Meth • Contains- Ephedrine/Pseudoephedrine • Assessment-rapid speech, violence and paranoia, Meth mouth • Treatment-ABC, treat signs and Symptoms-----Excited Delirium

  19. Methamphetamine

  20. Specific • Cannabis compounds • Example- K2 and SPICE • More potent hard to control dosages • Assessment-Loss of Control, Decreased pain response, delusions • Treatment-Safety, Supportive

  21. Brands

  22. Specific • Club/Rave Drugs • Examples-Ecstasy, Roofies (rohypnol) • Effects-Ecstasy=Reduces inhibitions and eliminates anxiety/Roofies=Relaxation and drowsiness, Dangerous when consumed with alcohol (Date Rape Drug) • Assessment-Ecstasy=Constant motion, Excessive talking/Roofies=If mixed with alcohol coma Decreased HR and RR • Treatment-Ecstasy-monitor temperature/hydration. Roofies=SANE capable hosp.

  23. Specific • Prescription and OTC medications • Examples-Robotussin, Corcidin, Krocodill, Skittles Parties • Effects-Dextromethorphan long acting anesthetic and depressant/Krocodil=tissue necrosis/Skittles Parties=Clean out the medicine cabinets. • Assessment-Loss of motor control(like they are intoxicated) Seizures • Treatment-ABC- Supportive-treat signs and symptoms, PCC

  24. Krocodil tissue damage

  25. Specific • Plants • Examples-Salvia Divinorium aka Magic Mint, Sally-D • Effect-Hallucinogenic, users report it is just intense as Mescaline. Not controlled by DEA. • Assessment-Hallucinations, Delusion

  26. Sally-D

  27. General Management • Scene Size-Up • What is the call • Be alert to the potential for violence. • Restraints • Look for signs of hazardous material/Drugs/suspicious material • Pill bottles • Meth equipment • Resources • Suicidal Patients and Protective Custody Involve law enforcement/medical direction. Know local laws and procedures

  28. General Management • Primary Assessment • ABC • Transport decision • Secondary • Obtain Hx • Identify the toxin and length of exposure • Rapid head to toe assessment • Monitor vital signs closely • Hx from Family members/Poison control

  29. General Management • Drug removal • Reduce intake/Remove the individual from the toxic environment. • Reduce absorption of toxins in the body. • NG tube and activated charcoal. • Enhance elimination of the toxin • Antidotes

  30. Drugs • Names-naloxone, Narcan • Action-Narcotic Antagonist, competes for opiate receptors in the brain. It also displaces narcotic molecules from receptors. • Indications-For reversal of depression cause by the following (MSO4, Demerol, Heroin, Dilaudid, codeine, Percodan, Fentanyl, Methadone. Tx of coma of unknown origin • Dose and Route- 1 to 2 mg SIVP, IM, and SQ. 2mg IN • Contraindications/Precautions-Hypersensitivity, Narcan should be admin cautiously to patient who are known to be physically dependent on narcotics

  31. Drugs Names- Sodium Bicarbonate, Bicarb Action-Alkanlinizing agent, salt that provides bicarbonate to buffer metabolic acidosis Indication-TCA overdose Dosage and Route-1meq/kg initial followed by .5 meq/kg q 10 min IV for persistent or prolonged QRS Contraindications/Precaution-None in TCA overdose, do not admin with calcium chloride. Weight important when calculating doses

  32. Drugs Names-GlucaGen Action-Glucagon has direct myocardial action and has been investigated as an inotrope in both ischemic and non-ischemic heart failure Indications-Calcium Channel Blocker and Beta Blocker OD Dosage and Route-1mg IV or IM Contraindications-Allergies to Protein

  33. Drugs Names-Romazicon Action-Benzo. Antagonist, inhibits action on GABA/Benzo. Complex. Reverses sedation Indication-Complete and partial reversal of CNS and respiratory depression. From the following agents Valium , Versed, Ativan, Restoril, Ambien, Klonopin, Xanax Dosage and Route-.2mg up 1.0mg Contraindication-TCA overdoses or people with a hx of szr. Precaution-Causes szr.

  34. Nerve Agents

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