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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*