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Emergency Care, Tel!th Edition
"i##er $ %&'ee!e $ (ic)inson
Introduction to EmergencyIntroduction to Emergency
Medical CareMedical Care
11
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OBJECTIVESOBJECTIVES
23.1 (e!ine )ey ter#s introduced in this chapter. *lides
12, 1+, 2, 1, -+, , /+
23.2 (escribe ays in hich poisons can enter the body.
*lide 1
23.3 Identi!y potential dangers to E* providers and
others at scenes here poisoning, alcohol abuse, or
substance abuse is involved. *lides 2, , 2, 2
continued
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OBJECTIVESOBJECTIVES
23.4 Collect )ey ele#ents in the history o! a patient ho
has been poisoned. *lides 120, -
23.5 (escribe the use o! activated charcoal in the
#anage#ent o! ingested poisons. *lides 22
23. E3plain the #anage#ent o! patients ho have
ingested a poison. *lides 222
continued
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OBJECTIVESOBJECTIVES
23.! (evelop a plan !or #anaging patients ho have
inhaled poisons. *lides , -0, -
23." (evelop a plan !or #anaging patients ho have
absorbed poisons through the s)in. *lide -
23.# (escribe the health ris)s associated ith alcohol
abuse. *lides 02
continued
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OBJECTIVESOBJECTIVES
23.1$ 4ecogni5e the signs and sy#pto#s o! alcohol
abuse and ithdraal. *lides -+
23.11 4ecogni5e signs, sy#pto#s, and health ris)s
associated ith abuse o! substances, including
sti#ulants, depressants, narcotics, volatile
che#icals, and hallucinogens. *lides /+/
continued
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OBJECTIVESOBJECTIVES
23.12 6iven a variety o! scenarios, develop a treat#ent
plan !or patients ith e#ergencies related to alcohol
and substance abuse. , 02
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M%&TIME'I(M%&TIME'I(
$ *lide Cocaine 7ideo
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CO)E CO*CE+TS
$ 8o to )no i! a patient has been
poisoned
$Assess#ent and care !or ingested poisons$ Assess#ent and care !or inhaled poisons
$ Assess#ent and care !or absorbed
poisons
continued
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CO)E CO*CE+TS
$ Assess#ent o! in9ected poisons
$ Assess#ent and care !or alcohol abuse
$ Assess#ent and care !or substanceabuse
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Emergency Care, Tel!th Edition
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TopicsTopics
$ Poisoning
$ Alcohol and *ubstance Abuse
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+oi,oning+oi,oning
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PoisonPoison
$ A poison is any substance that can har#
the body
$ The har# it can cause can result in a
#edical e#ergency
$ :All things are poison and nothing is
ithout poison, only the dose per#its
so#ething not to be poisonous.;
Paracelsus
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Emergency Care, Tel!th Edition
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Co##on PoisonsCo##on Poisons
$ edications
$ Petroleu# products
$ Cos#etics$ Pesticides
$ Plants
$
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E!!ects o! a PoisonE!!ects o! a Poison
$ 8ar# to body based on nature o! poison,
concentration, route o! entry, patient&s age
and health
$ (a#age to s)in and tissues !ro# contact
$ *u!!ocation
$ "ocali5ed or syste#ic da#age to bodysyste#s
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Classi!ication o!Classi!ication o!
Poisons =>y 4outes o! Entry?Poisons =>y 4outes o! Entry?
$ Ingested
$ Inhaled
$ Absorbed$ In9ected
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Ingested PoisonIngested Poison
$ Child@ #ay accidentally eat or drin) a to3ic
substance
$ Adult@ o!ten an accidental or deliberate
#edication overdose
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Assess#ent@Assess#ent@
Ingested PoisonsIngested Poisons$ hat substance as involvedB
"oo) !or container chec) labels
Transport ith patient to hospital
$ hen did e3posure occurB
Duic)acting poison reFuires !aster treat#ent
E4 personnel need to )no !or appropriate
testing and treat#ent
continued
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Assess#ent@Assess#ent@
Ingested PoisonsIngested Poisons$ 8o #uch as ingestedB
Esti#ate #issing pills by loo)ing at
prescription label
$ %ver ho long a ti#eB
Treat#ents #ay vary
$ as #edication ta)en !or very !irst ti#eB
$ as #edication being ta)en chronicallyB
continued
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Assess#ent@Assess#ent@
Ingested PoisonsIngested Poisons$ hat interventions have been ta)enB
Treat#ents indicated on label,
%ther ho#e re#edies =syrup o! ipecac?
$ hat is patient&s eightB
4ate o! onset o! to3ic e!!ects is related to
eight
continued
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Emergency Care, Tel!th Edition
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Assess#ent@Assess#ent@
Ingested PoisonsIngested Poisons$ hat e!!ects has patient e3periencedB
Gausea, vo#iting, altered #ental status,
abdo#inal pain, diarrhea, che#ical burns
around #outh, unusual breath odors
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Emergency Care, Tel!th Edition
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Treat#entTreat#ent--
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Activated CharcoalActivated Charcoal
$ or)s through adsorption, alloing
substances to attach to its sur!ace
$ Not an antidote@ prevents or reduces
a#ount o! poison absorbed by body
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Treat#ent@ Activated CharcoalTreat#ent@ Activated Charcoal
continued
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Treat#ent@ Activated CharcoalTreat#ent@ Activated Charcoal
continued
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Treat#ent@ Activated CharcoalTreat#ent@ Activated Charcoal
continued
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Treat#ent@ Activated CharcoalTreat#ent@ Activated Charcoal
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Thin) About ItThin) About It
$ Thin) about your on ho#e. Is it sa!e !or a
s#all childB
$ Are there potential poisons ithin three
!eet o! the !loor, or behind unloc)ed
doorsB
$ Are there household cleaners that loo)
li)e 9uices and drin)s !a#iliar to childrenB
continued
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Thin) About ItThin) About It
$ Can !lavored children&s #edications be
#ista)en !or candyB
$ hat sense does a s#all child typically
use to identi!y thingsB
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Emergency Care, Tel!th Edition
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Public EducationPublic Education
$ any E* agencies are involved in
educating the public to the dangers o!
child poisoning
$ Childproo!ing ho#es
$ r. Hu)
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Emergency Care, Tel!th Edition
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Inhaled PoisonsInhaled Poisons
$ Co##on types
Carbon #ono3ide
A##onia
Chlorine
Agricultural che#icals and pesticides
Carbon dio3ide
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*cene *a!ety*cene *a!ety
$ Approach scene ith
caution
$ Protective clothing
and sel!containedbreathing apparatus
#ay be reFuired
$ I! not trained or
eFuipped, call !or
additional resources
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*igns and*igns and
*y#pto#s@ Inhaled Poisons*y#pto#s@ Inhaled Poisons$ (i!!iculty breathing
$ Chest pain
$ Coughing$ 8oarseness
$ 8eadache, con!usion, altered #ental
status$ *ei5ures
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Assess#ent@ Inhaled PoisonsAssess#ent@ Inhaled Poisons
$ hat substance is involved =e3act na#e?B
$ hen did e3posure occurB
$ %ver ho long did e3posure occurB$ hat interventions has anyone ta)enB
$ 4e#ove patientB
$ 7entilate areaB$ hat e!!ects is patient e3periencingB
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"i##er $ %&'ee!e $ (ic)inson
Treat#ent@ Inhaled PoisonsTreat#ent@ Inhaled Poisons
$ ove patient !ro# unsa!e environ#ent
using trained and eFuipped personnel
$ %pen airay provide high !lo o3ygen
$ 8istory, physical e3a#, vital signs
$ Transport ith all containers, bottles, and
labels$ %ngoing assess#ent en route
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Emergency Care, Tel!th Edition
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Carbon ono3ideCarbon ono3ide
=C%? Poisoning=C%? Poisoning
$ Colorless, odorless, tasteless gas created
by co#bustion
$ Can be caused by i#proper venting o!
!ireplaces, portable heaters, generators
$ Co##on cause o! death during inter and
poer outages
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Emergency Care, Tel!th Edition
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*igns and*igns and
*y#pto#s@ C% Poisoning*y#pto#s@ C% Poisoning$ 8eadache =band around head?
$ (i55inessnausea
$ >reathing di!!iculty$ Cyanosis
$ ay be #ultiple patients ith si#ilar
sy#pto#s in con!ined area together
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Emergency Care, Tel!th Edition
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C% onitorC% onitor
$ *o#e !ireE*
syste#s have
#onitoring devices
that allo cres todeter#ine C%
e3posure levels in
the !ield
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C% (etectorsC% (etectors
$ Public education progra#s should
encourage people to have both s#o)e
and C% detectors in their ho#es to reduce
the ris) o! in9ury and death
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Emergency Care, Tel!th Edition
"i##er $ %&'ee!e $ (ic)inson
Treat#ent@ C% PoisoningTreat#ent@ C% Poisoning
$ 8igh !lo o3ygen is appropriate treat#ent,
but C% bonds to red blood cells #uch
#ore strongly than o3ygen does
$ Can ta)e several hours or days to :ash;
C% !ro# bloodstrea#
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*#o)e Inhalation*#o)e Inhalation
$ *#o)e !ro# burning #aterials can contain
poisonous and to3ic substances, including
C%, a##onia, chlorine, cyanide
$ *ubstances can irritate s)in and eyes,
da#age lungs, and progress to respiratory
or cardiac arrest
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*igns and*igns and
*y#pto#s@ *#o)e Inhalation*y#pto#s@ *#o)e Inhalation$ (i!!iculty breathing
$ Coughing
$ :*#o)y; or che#ical s#ell on breath$ >lac) =carbon? residue in #outh, nose or
sputu#
$ *inged nasal or !acial hair
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Emergency Care, Tel!th Edition
"i##er $ %&'ee!e $ (ic)inson
Treat#ent@ *#o)e InhalationTreat#ent@ *#o)e Inhalation
$ ove patient to sa!e area
$ aintain airay provide high !lo o3ygen
$ onitor patient closelyJairay burns #aylead to selling o! airay
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Emergency Care, Tel!th Edition
"i##er $ %&'ee!e $ (ic)inson
::(etergent *uicides;(etergent *uicides;
$ ethod o! suicide started in Kapan and
beco#ing #ore co##on in the L.*.
$ i3 to easilyobtained che#icals to
release hydrogen sul!ide gas
$ Co##only released inside enclosed
space such as a car
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Emergency Care, Tel!th Edition
"i##er $ %&'ee!e $ (ic)inson
::(etergent *uicides;@(etergent *uicides;@
*cene *a!ety*cene *a!ety
$ E3posure to !u#es #ay in9ure E*
personnel
$ arning note #ay be le!t on vehicle, but
this is not assured
$ ay need to treat !irst as a ha5#at scene
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Emergency Care, Tel!th Edition
"i##er $ %&'ee!e $ (ic)inson
Absorbed PoisonsAbsorbed Poisons
$ Can be absorbed through s)in
$ ay or #ay not cause da#age to s)in
$ Patient #ay reFuire deconta#ination priorto treat#ent
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Emergency Care, Tel!th Edition
"i##er $ %&'ee!e $ (ic)inson
Treat#ent@ Absorbed PoisonsTreat#ent@ Absorbed Poisons
$ Assess !or i##ediate li!e threats
$ 8istory, physical e3a#, vital signs
$>rush o!! poder, then irrigate
$ Irrigate s)in and eyes !or at least 20
#inutes and during transport
$ Transport ith all containers$ %ngoing assess#ent en route
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Emergency Care, Tel!th Edition
"i##er $ %&'ee!e $ (ic)inson
Poison Control CentersPoison Control Centers
$ E3cellent resource
$ In!or#ation on poisons, signs and
sy#pto#s, and treat#ents
$
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Emergency Care, Tel!th Edition
"i##er $ %&'ee!e $ (ic)inson
(lcool and Su/,tance(lcool and Su/,tance
(/u,e(/u,e
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Emergency Care, Tel!th Edition
"i##er $ %&'ee!e $ (ic)inson
Alcohol and *ubstance AbuseAlcohol and *ubstance Abuse
$ *ee #any patients hose conditions are
caused either directly or indirectly by
alcohol or substance abuse
$ Abuse o! alcohol and other drugs crosses
all geographic and econo#ic boundaries
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Emergency Care, Tel!th Edition
"i##er $ %&'ee!e $ (ic)inson
Alcohol AbuseAlcohol Abuse
$ Potent drug a!!ects central nervous
syste#
$ Can be addictive
$ E#ergencies #ay result !ro# recent
consu#ption or years o! abuse
$ Treat patients as any others
$ Abuse can lead to or orsen other
#edical conditionscontinued
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Emergency Care, Tel!th Edition
"i##er $ %&'ee!e $ (ic)inson
Alcohol AbuseAlcohol Abuse
$ Alcohol o!ten consu#ed ith other drugs,
hich can result in a serious #edical
e#ergency
$ I#paired patients can be uncooperative or
co#bative
$ Contact la en!orce#ent i! sa!ety concern
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Emergency Care, Tel!th Edition
"i##er $ %&'ee!e $ (ic)inson
Assess#ent@ Alcohol AbuseAssess#ent@ Alcohol Abuse
$ any #edical conditions #i#ic alcohol
into3ication
$ Into3icated patients #ay also have
#edical proble#s
$ All patients receive !ull assess#ent
regardless o! suspicion o! into3ication
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Emergency Care, Tel!th Edition
"i##er $ %&'ee!e $ (ic)inson
*igns and*igns and
*y#pto#s@ Alcohol Abuse*y#pto#s@ Alcohol Abuse$ Alcohol odor on breath
$ Lnsteady on !eet
$ *lurred, ra#bling speech
$ lurred vision
$ Con!usionaltered #ental status
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Emergency Care, Tel!th Edition
"i##er $ %&'ee!e $ (ic)inson
Alcohol ithdraalAlcohol ithdraal
$ Abrupt cessation o! drin)ing #ay cause
so#e alcoholics to su!!er !ro# deliriu#
tre#ens =(Ts?
$ Can be serious, resulting in tre#ors,
hallucinations, and sei5ures
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Emergency Care, Tel!th Edition
"i##er $ %&'ee!e $ (ic)inson
*igns and*igns and
*y#pto#s@ Alcohol ithdraal*y#pto#s@ Alcohol ithdraal
$ Con!usion and restlessness
$ Lnusual behavior, de#onstrating :insane;
behavior
$ 8allucinations, gross tre#or o! hands,
pro!use seating
$ *ei5ures
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Emergency Care, Tel!th Edition
"i##er $ %&'ee!e $ (ic)inson
Patient Care@ Alcohol AbusePatient Care@ Alcohol Abuse
$ 7o#iting co##on standard precautions
are essential
$ 'eep suction ready
$ *tay alert !or airay and respiratory
proble#s
$ onitor vital signs
$ 6ather history !ro# patient, bystanders
$ *tay alert !or sei5ures
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Emergency Care, Tel!th Edition
"i##er $ %&'ee!e $ (ic)inson
*ubstance Abuse*ubstance Abuse
$ Any che#ical substance ta)en !or other
than therapeutic =#edical? reasons
$ Includes illicit
drugs, prescription
#edications,
industrial
che#icals
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Emergency Care, Tel!th Edition
"i##er $ %&'ee!e $ (ic)inson
LppersLppers
$ *ti#ulants that a!!ect the nervous syste#
$ Cocaine
$ A#pheta#ines
$ ay be snorted, s#o)ed, or in9ected
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Emergency Care, Tel!th Edition
"i##er $ %&'ee!e $ (ic)inson
(oners(oners
$ Central nervous syste# depressants
$ >arbiturates
$ 4ohypnol =4oo!ies?
$ 68>
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Emergency Care, Tel!th Edition
"i##er $ %&'ee!e $ (ic)inson
GarcoticsGarcotics
$ Lsed to relieve pain or help ith sleep
$ %piates
8eroin, codeine, #orphine
$ %3ycodone
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Emergency Care, Tel!th Edition
"i##er $ %&'ee!e $ (ic)inson
8allucinogens8allucinogens
$ Create intense state o! e3cite#ent and
distorted perception
$ "*(, PCP, MTC
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Emergency Care, Tel!th Edition"i##er $ %&'ee!e $ (ic)inson
7olatile Che#icals7olatile Che#icals
$ Produce vapors
that are inhaled
$ Initial :rush,; then
can act as central
nervous syste#
depressant
A tA t
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Assess#ent@Assess#ent@
*ubstance Abuse*ubstance Abuse$ ay be di!!icult
Patient&s level o! consciousness
Patient #ay have ta)en #ore than one type o!
drug
$ Patient #ay be uncooperative or
co#bative
$ >e aare o! a possibility o! conta#inatedneedles and the presence o! che#icals
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*igns and *y#pto#s@ (oners*igns and *y#pto#s@ (oners
$ *luggishness, poor coordination
$ (ecreased pulse and respirations
*i d*i d
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*igns and*igns and
*y#pto#s@ Lppers*y#pto#s@ Lppers$ E3cite#ent, restlessness
$ Increased pulse and respirations
$ *eating
$ 8yperther#ia
$ Go sleep !or a long ti#e, possibly days
*i d*i d
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*igns and*igns and
*y#pto#s@ Garcotics*y#pto#s@ Garcotics$ "ethargy =patient very sleepy?
$ Pinpoint pupils
$ Cool s)in
$ 4espiratory depression
$ Co#a
*i d*i d
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*igns and*igns and
*y#pto#s@ 8allucinogens*y#pto#s@ 8allucinogens$ 4apid pulse
$ (ilated pupils
$
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*igns and*igns and
*y#pto#s@ 7olatile Che#icals*y#pto#s@ 7olatile Che#icals$ (a5eddisoriented
$ *ollen #e#branes in nose or #outh
$ Gu#bness or tingling sensation inside
head
$ Changes in heart rhyth#
$ ay be residue o! che#ical on !ace or inbag
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Treat#ent@ *ubstance AbuseTreat#ent@ *ubstance Abuse
$ >e aare o! possible airay proble#s and
respiratory distress
$ Provide o3ygen and assist respirations as
needed
$ Treat !or shoc)
$ Tal) to patient to )eep the# cal# and
cooperative
continued
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Treat#ent@ *ubstance AbuseTreat#ent@ *ubstance Abuse
$ Per!or# physical
e3a#
$ "oo) !or evidence
o! in9ection sites=:trac) #ar)s;?
continued
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Treat#ent@ *ubstance AbuseTreat#ent@ *ubstance Abuse
$ Transport as soon as possible
$ Consult ith #edical control on !urther
treat#ent
$
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Cocaine 7ideoCocaine 7ideo
Clic) here to vie a video on the sub9ect o! cocaine dependency.
>ac) to (irectory
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Chapter ReviewChapter Review
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Chapter 4evieChapter 4evie
$ Per!or# pri#ary assess#ent and
i##ediately treat li!ethreatening
proble#s. Ensure an open airay.
Ad#inister highconcentration o3ygen i!the poison as inhaled or in9ected.
continued
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continued
Chapter 4evieChapter 4evie
$ Per!or# a history and physical e3a#,
including baseline vital signs.
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Chapter 4evieChapter 4evie
$ Consult #edical direction. As directed,
ad#inister activated charcoal, ater, or
#il) !or ingested poisons.
$ 4e#ove patient ho has inhaled poison!ro# the environ#ent and ad#inister high
concentration o3ygen re#ove poisons
!ro# s)in by brushing o!! or diluting.
continued
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Chapter 4evieChapter 4evie
$ Transport patient ith all containers,
bottles, and labels !ro# substance.
$ 4eassess patient en route.
$ Care!ully docu#ent all in!or#ation about
poisoning, interventions, and patient&s
responses.
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4e#e#ber4e#e#ber
$ *a!ety is alays the !irst concern hen
dealing ith a poisoning or substance
abuse patient.
$ Poisonings are generally classi!ied byroute o! e3posure. E!!ects vary greatly,
depending upon type o! poison and
#ethod o! entrance into body.
continued
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4e#e#ber4e#e#ber
$ ETs #ust use thorough assess#ent,
including scene clues, to help identi!y the
nature and severity o! poisoning.
$ Poison control centers o!!er a ealth o!resources to assist in assess#ent and
treat#ent o! poisoning patient.
continued
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4e#e#ber4e#e#ber
$ Alcohol is a co##on underlying issue ith
patients. In so#e patients it #ay be the
#ost signi!icant proble#.
$ The e!!ects o! substance abuse can varygreatly, based on the type o! substance.
(eter#ining the type o! drug ingested can
shed light on e!!ects to co#e.
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Duestions to ConsiderDuestions to Consider
$ hat are potential ris)s to the responder
on a poisoning or overdose callB
$ hat are the routes o! entry into the
bodyB
$ hat are so#e things E* can do to
prevent poisonings, especially in childrenB
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Critical Thin)ingCritical Thin)ing
$ A !ar#er calls /11 because one o! his !ar#
hands has tried to clean up spilled
pesticide poder ith his hands. %n
arrival, you !ind that the patient insists hehas brushed all the poder o!!, !eels !ine,
and doesn&t need to go to the hospital.
continued
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Critical Thin)ingCritical Thin)ing
$ As he tal)s, he continues to #a)ebrushing #otions at his 9eans on hich
you can see the #ar)s o! a podery
residue. 8o do you #anage thesituationB
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