PoisoningTemple CollegeEMS Professions

PoisonsSubstance 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 behaviorPupil changes, salivation, sweating, other signs/symptoms of disturbed autonomic nervous system functionRespiratory depressionBurns, blisters of lips, mucous membranesUnusual breath odors

Treat Patient, Not PoisonProper support of ABCs is first step in management

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

When in doubt. . .Assume containers were fullEntire contents were ingested

If several patients involved. . .Assume each ingested entire container contents

Always. . .Bring sample of material if possibleSave for analysis, if patient vomitsCall poison center for advice on management

Poisoning ManagementBased on route of entryIngestedAbsorbedInhaledInjected

Ingested PoisonsPrevent absorption of toxin from GI tract into bloodstreamActivated charcoalSyrup of Ipecac

Activated CharcoalAdsorbs toxin, prevents absorption from GI tract

Activated CharcoalNamesSuperCharInstaCharActidoseLiqui-Char

Activated CharcoalFormPremixed in water (slurry)Usually bottle containing 12.5 gms

Activated CharcoalDosage1 gm/kg of patient body weightUsual adult dose: 25 to 50 gmsUsual child dose: 12.5 to 25 gms

Activated CharcoalContraindicationsAltered mental statusInability to swallowIngestion of acids or alkalisDoes not bindAlcoholPetroleum productsMetals (iron)

Activated CharcoalSide EffectsNausea, vomitingBlack stools

Activated CharcoalAdministrationShake container thoroughlyUse covered opaque containerHave patient drink through strawIf patient vomits dose may be repeated

Syrup of IpecacInduces vomiting by irritating stomach and stimulating vomiting center in brainstemSeldom used anymoreMay be helpful if ingestion has occurred within last 30 minutes

Syrup of IpecacDoseChildren = 15 cc orallyAdults = 30 cc orallyRepeat once after 20 minutes as neededBe sure patient has H20 in stomachShould not be given at same time as activated charcoal

Syrup of IpecacContraindicationsDecreased level of consciousnessSeizing or has seizedCaustic poison (acids or alkalis)Petroleum based products

Absorbed PoisonsDry chemicalsdust skin, then washLiquid chemicalswash with large amounts of H20avoid neutralizing agentsCAUTION Dont accidentally expose yourself!

Inhaled PoisonsRemove patient from exposureMaximize oxygenation, ventilationCAUTION Dont accidentally expose yourself!

Injected PoisonsAttempt to slow absorptionVenous constricting bandsDependent positionSplinting of injected body partCold packs (+) [May worsen local injury by concentrating poison]

Drug Abuse/Overdose

Substance AbuseSelf administration of a substance in a manner not in accord with approved medical or social practices

Substance AbusePsychological dependencePhysical dependenceCompulsive drug useToleranceAddiction

Psychological DependenceHabituationSubstance needed to support users sense of well-being

Physical DependenceSubstance must be present in body to avoid physical symptoms (withdrawal)

Compulsive Drug UseUse of drug and rituals/culture associated with its use become an overwhelming desire

ToleranceIncreasing amounts of drug needed to produce same effectsTolerance contributes to addiction by keeping user chasing the last high

AddictionCombination of psychological dependence, physical dependence, compulsive use, and tolerancePatient becomes totally consumed with obtaining, using drug to exclusion of all other things

Ethyl Alcohol (EtOH)

Ethyl AlcoholA CNS Depressant Drug

Decreased Reaction Time

Increased Accidental Trauma Risk

Decreased Social Inhibitions

Increased Intentional Trauma Risk

Potentiation of Other CNS Depressants

Lethal Overdoses in Combination with Other Drugs

Slowed GI Tract Activity

Irritation, Gastritis, Ulcer Disease, GI Bleeds

Toxic Overdose

Respiratory Depression, Shock

Ethanol Intoxication SignsBreath odorSwaying, unsteadinessSlurred speechNausea, vomitingFlushed faceDrowsinessViolent, erratic behavior

EthanolClouds signs, symptomsComplicates assessmentHead trauma, diabetes, drug toxicity, CNS infection can mimic EtOH intoxication and vice versa

Patient is NEVER just drunk until all other possibilities are excluded

Experience alcohol withdrawal syndrome if they reduce intake:Restlessness, tremulousnessHallucinationsSeizuresDelirium tremens--all of above plus tachycardia, nausea, vomiting, hypertension, elevated body temperature Alcohol Addicts

Life threatening condition!Occurs 1 days to 2 weeks after intake is decreased5 to 15% mortalityControl airway, prevent aspiration, monitor for hypovolemiaDelirium Tremens

NarcoticsOpiumOpium derivativesSynthetic compounds that produce opium-like effects

NarcoticsOpiumHeroinMorphineDemerolDilaudid

PercodanCodeineDarvonTalwin

NarcoticsMedical Usesanalgesicsanti-diarrheal agentscough suppressants

NarcoticsOverdoseComaRespiratory depressionConstricted (pin-point) pupils

NarcoticsWithdrawalAgitationAnxietyAbdominal painDilated pupils

SweatingChillsJoint painsGoose fleshResembles severe influenzaNot a life-threat

NembutalSeconalPentobarbitalAmytalTuinalPhenobarbitalBarbiturates

Induce sleepiness, state similar to EtOH intoxicationMedical usesAnestheticsSedativeHypnotics

Barbiturates

BarbituratesOverdoseComaRespiratory depressionShockExtremely dangerous in combination with EtOH

BarbituratesWithdrawalResembles EtOH withdrawal (DTs) Extremely dangerous

Barbiturate-like Non-barbituratesDoriden, Placidyl, Quaalude, MethyprylonEffects similar to barbituratesOverdose can cause sudden, very prolonged respiratory arrestWithdrawal resembles ETOH; extremely dangerous

Valium, Librium, Miltown, Equanil, TranxeneLow doses relieve anxiety, produce muscle relaxationHigh doses produce barbiturate-like effectsTranquilizers

Overdose:Unlikely to cause respiratory arrest alone Extremely dangerous with EtOHWithdrawalResembles EtOH withdrawalExtremely dangerousTranquilizers

CNS Stimulants: AmphetaminesDexedrine, Benzedrine, Methyl amphetamineRelieve fatigue, promote euphoria, reduce appetite

CNS Stimulants: AmphetaminesOverdoseRestlessness, paranoiaTachycardiaHypertension CVA, Heart failureHyperthermia Heat strokeWithdrawalLethargyDepression

Stronger stimulant effects than amphetaminesCan cause respiratory/cardiovascular failure, heat stroke, lethal arrhythmiasCNS Stimulants: Cocaine

Snorting can destroy nasal septum, cause massive nosebleedWithdrawal: lethargydepressionCNS Stimulants: Cocaine

LSD, psilocybin, peyote, mescaline, DMT, MDMAEnhance perceptionWrong setting may induce bad trips with extreme anxietyTrue toxic overdose rareHallucinogens

PhencyclidinePCP, angel dustProduces bizarre, violent behaviorReduces pain sensationPatients may be capable of feats of extreme strengthKeep patient in quiet environment, minimize stimulatin

Glue, paint, gas, light fluid, tolueneInhalation produces state similar to EtOH intoxicationPatient may asphyxiate if consciousness lost while sniffingSolvents

Increase risk of arrhythmiasMay cause liver damage, bone marrow depressionChronic abuse causes CNS damage - paranoia, violent behavior

Solvents

*Temple College EMS Professions*