Chapter 10

1. Chapter 10 Poisoning and Substance Abuse

2. National EMS Education Standard Competencies (1 of 5) Medicine Recognizes and manages life threats based on assessment findings of a patient with a medical emergency while awaiting additional emergency response.

3. National EMS Education Standard Competencies (2 of 5) Toxicology • Recognition and management of • Carbon monoxide poisoning • Nerve agent poisoning • How and when to contact a poison control center

4. National EMS Education Standard Competencies (3 of 5) Immunology Recognition and management of shock and difficulty breathing related to • Anaphylactic reactions Pharmacology Uses simple knowledge of the medications that the EMR may self-administer or administer to a peer in an emergency.

5. National EMS Education Standard Competencies (4 of 5) Medication Administration Within the scope of practice of the EMR, how to • Self-administer medication • Peer-administer medication

6. National EMS Education Standard Competencies (5 of 5) Emergency Medications Within the scope and practice of the EMR • Names • Effects • Indications • Routes of administration • Dosages for the medication administered

7. Introduction • A poison is a substance that causes illness or death when eaten, drunk, inhaled, injected, or absorbed in relatively small quantities. • EMRs can save patients’ lives by quickly recognizing and promptly treating serious poisonings.

8. Patient Assessment for Poisoning (1 of 5) • Poisoning can be classified according to the way the poison enters the body. • Ingestion: Poison enters through the mouth and is absorbed by the digestive system. • Inhalation: Poison enters through the mouth or nose and is absorbed by the mucous membranes lining the respiratory system.

9. Patient Assessment for Poisoning (2 of 5) • Poison classifications (cont’d) • Injection: Poison enters through a small opening in the skin and spreads through the circulatory system. • Absorption: Poison enters through intact skin and spreads through the circulatory system.

10. Patient Assessment for Poisoning (3 of 5)

11. Patient Assessment for Poisoning (4 of 5) • General assessment and treatment • Follow the patient assessment sequence. • Obtain a thorough history from the patient or from bystanders. • Be alert for visual clues that may indicate poisoning. • Much of the emergency care depends on the patient’s signs and symptoms.

12. Patient Assessment for Poisoning (5 of 5)

13. Ingested Poisons (1 of 2) • More than 80% of all cases of poisonings are caused by ingestion. • Chemical burns, odors, or stains may be found around the patient’s mouth. • Signs and symptoms • Nausea • Vomiting • Abdominal pain

14. Ingested Poisons (2 of 2) • Signs and symptoms (cont’d) • Diarrhea • Abnormal or decreased respirations • Loss of consciousness • Seizures

15. Treatment for Ingested Poisons (1 of 5) • Identify the poison. • Call the National Poison Center for instructions, and follow these instructions. • If you are unable to contact the poison center, dilute the poison by giving water. • Arrange for prompt transport to a hospital.

16. Treatment for Ingested Poisons (2 of 5) • Dilution • Most poisons can be diluted by giving the patient large quantities of water. • The patient must be conscious and able to swallow.

17. Treatment for Ingested Poisons (3 of 5) • Activated charcoal • Finely ground powder mixed with water • Works by binding to the poison, thereby preventing the poison from being absorbed in the patient’s digestive tract • Do not give if the patient: • Has ingested an acid or an alkali • Has ingested a base • Is unconscious

18. Treatment for Ingested Poisons (4 of 5) • Activated charcoal (cont’d) • Usual dose: • 25 to 50 grams for an adult patient • 12.5 to 25 grams for a pediatric patient • Serve it in a covered cup and give the patient a straw.

19. Treatment for Ingested Poisons (5 of 5) • Vomiting • In the past, syrup of ipecac was used to induce vomiting. • Today, it is recommended in only a few situations. • Inducing vomiting may cause the patient to inhale the vomit into the lungs. • Activated charcoal is considered more effective and safer than syrup of ipecac.

20. Inhaled Poisons (1 of 2) • Occurs if a toxic substance is breathed in and absorbed through the lungs • Some toxic substances (carbon monoxide) are very poisonous but not irritating. • Other toxic gases (chlorine gas and ammonia) are very irritating to the respiratory tract.

21. Inhaled Poisons (2 of 2) • Signs and symptoms • Respiratory distress • Dizziness • Cough • Headache • Hoarseness • Confusion • Chest pain

22. Carbon Monoxide (1 of 2) • Common causes of carbon monoxide poisoning include: • Improperly vented heating appliances • Smoke (burning buildings)

23. Carbon Monoxide (2 of 2) • Signs and symptoms • Headache • Nausea • Disorientation • Unconsciousness • Flulike symptoms • If you find several patients together who all reportthese symptoms, remove everyone from the structure or vehicle.

24. Irritants (1 of 4) • Ammonia • Often found in agricultural settings • Has a strong, irritating odor • Is highly toxic • Causes violent coughing and skin burns • Anyone who enters an environment containing ammonia must wear a proper encapsulating suit with a SCBA.

25. Irritants (2 of 4) Courtesy of Lynn Betts/NRCS Courtesy of Scott Health & Safety

26. Irritants (3 of 4) • Chlorine • Found around swimming pools and water treatment plants • Is severely irritating to the lungs and upper respiratory tract • Causes violent coughing and skin burns • Anyone who enters an environment containing chlorine must wear a proper encapsulating suit with a SCBA.

27. Irritants (4 of 4) • The presence of hazardous materials that are toxic and those in which there is a danger of fire or explosion should be indicated by the appropriate placards. © Mark Winfrey/ShutterStock, Inc.

28. Treatment for Inhaled Poisons • Remove the patient from the source of the gas. • If the patient is not breathing, begin mouth-to-mask breathing. • If the patient is breathing, administer large quantities of oxygen. • Arrange for prompt transport. • You may have to evacuate people first.

29. Injected Poisons (1 of 2) • The two major causes of poisoning by injection are: • Animal bites and stings • Toxic injection

30. Injected Poisons (2 of 2) • Signs and symptoms • Obvious injury site (bite or sting marks) • Tenderness • Swelling • Red streaks radiating from the injection site • Weakness • Dizziness • Localized pain • Itching

31. Treatment for Insect Stings and Bites (1 of 5) • Keep the patient quiet and still. • A light constricting band may be used if there is severe swelling. • Apply ice packs to reduce swelling and pain. • Some people may experience an extreme allergic reaction and go into anaphylactic shock.

32. Treatment for Insect Stings and Bites (2 of 5) • Signs and symptoms of anaphylactic shock • Itching • Hives • Swelling • Wheezing and severe respiratory distress • Generalized weakness • Loss of consciousness

33. Treatment for Insect Stings and Bites (3 of 5) • Signs and symptoms of anaphylactic shock(cont’d) • Rapid, weak pulse • Rapid, shallow breathing • Treatment for anaphylactic shock • Maintain the patient’s ABCs. • Administer oxygen if available. • Elevating the patient’s legs may help.

34. Treatment for Insect Stings and Bites (4 of 5) • Treatment for anaphylactic shock (cont’d) • Remove the allergen if possible. • Monitor the patient’s vital signs. • If the patient’s condition progresses to the point of respiratory or cardiac arrest, begin mouth-to-mask breathing or CPR. • Immediately arrange for rapid transport.

35. Treatment for Insect Stings and Bites (5 of 5) • Treatment for anaphylactic shock (cont’d) • If the patient has a prescribed auto-injector, help the patient use it. • Place the tip of the auto-injector against the outer thigh. • Push the auto-injector firmly against the thigh and hold it for several seconds.

36. Snake Bites (1 of 3) • Four kinds of poisonous snakes in the United States: • Rattlesnake • Cottonmouth • Copperhead • Coral snake • A snake injects its poison into a person’s skin and muscles with its fangs.

37. Snake Bites (2 of 3) • Signs and symptoms • Immediate pain at the bite site • Swelling and tenderness around the bite site • Fainting (from the emotional shock) • Sweating • Nausea and vomiting • Shock

38. Snake Bites (3 of 3) • The bite of the coral snake delivers a slightly different poison that may cause these additional problems: • Respiratory difficulties • Slurred speech • Paralysis • Coma • Seizures

39. Treatment for Snake Bites • Keep the patient calm and quiet. • Have the patient lie down and try to relax. • Wash the bite area with soap and water. • If the bite occurred on the arm or leg, splint the affected extremity. • Treat the patient carefully. • Arrange for prompt transport to a hospital with antivenin.

40. Absorbed Poisons (1 of 2) • Occurs when a poisonous substance enters the body through the skin • Common absorbed poisons: • Insecticides • Toxic industrial chemicals • Signs and symptoms • Traces of powder or liquid on the skin • Inflammation or redness of the skin

41. Absorbed Poisons (2 of 2) • Signs and symptoms (cont’d) • Chemical burns • Skin rash • Burning • Itching • Nausea and vomiting • Dizziness • Shock

42. Treatment for Absorbed Poisons (1 of 2) • Ensure that the patient is no longer in contact with the toxic substance. • Brush—do not wash—any dry chemical off the patient. • Contact with water may activate the dry chemical and result in a burning reaction. • Wash the patient completely for at least 20 minutes.

43. Treatment for Absorbed Poisons (2 of 2) • If additional EMS personnel are delayed, contact the poison control center or your medical director for additional treatment. • If the patient is experiencing shock, have the patient lie down and elevate the legs. • If the patient is having difficulty breathing, administer oxygen.

44. Nerve Agents (1 of 5) • Nerve agents can be absorbed through the skin, inhaled, or injected. • They are among the most deadly chemicals developed. • Small quantities can kill large numbers of people by causing cardiac arrest within minutes of exposure.

45. Nerve Agents (2 of 5) • Nerve agents block an essential enzyme in the nervous system and cause these SLUDGE-like symptoms.

46. Nerve Agents (3 of 5) • Additional symptoms of organophosphate poisoning include: • Shortness of breath • Slow heart rate • Muscle weakness, twitching, or paralysis • Slurred speech • Seizures • Loss of consciousness

47. Nerve Agents (4 of 5) • Four of the most common nerve agents: • Sarin (GB) • Soman (GD) • Tabun (GA) • V agent (VX) • If you are called to the scene of a nerve agent poisoning, keep yourself, rescuers, and bystanders from being contaminated.

48. Nerve Agents (5 of 5) • A well-trained hazardous materials team in special protective equipment is needed to remove and decontaminate people. • SCBA and encapsulating suits are needed to prevent exposure to rescuers.

49. Treatment for Nerve Agents (1 of 2) • Assess and support the patient’s ABCs. • Nerve agent antidote kits: • DuoDote kit: contains one auto-injector syringe that contains atropine and pralidoxime chloride • Mark I kit: contains two auto-injector syringes—atropine and pralidoxime chloride

50. Treatment for Nerve Agents (2 of 2)