Poisoning
Temple College EMS Professions
Poisons
Substance 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 behavior Pupil changes, salivation, sweating, other signs/symptoms of disturbed autonomic nervous system function Respiratory depression Burns, blisters of lips, mucous membranes Unusual breath odors
Treat Patient, Not Poison
Proper 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 full Entire contents were ingested
If several patients involved. . .
Assume each ingested entire container contents
Always. . .
Bring sample of material if possible Save for analysis, if patient vomits Call poison center for advice on management
Poisoning Management
Based on route of entry
– Ingested – Absorbed – Inhaled – Injected
Ingested Poisons
Prevent absorption of toxin from GI tract into bloodstream
– Activated charcoal – Syrup of Ipecac
Activated Charcoal
Adsorbs toxin, prevents absorption from GI tract
Activated Charcoal
Names
– SuperChar – InstaChar – Actidose – Liqui-Char
Activated Charcoal
Form
– Premixed in water (slurry) – Usually bottle containing 12.5 gms
Activated Charcoal
Dosage
– 1 gm/kg of patient body weight – Usual adult dose: 25 to 50 gms – Usual child dose: 12.5 to 25 gms
Activated Charcoal
Contraindications
– Altered mental status – Inability to swallow – Ingestion of acids or alkalis
Does not bind
– Alcohol – Petroleum products – Metals (iron)
Activated Charcoal
Side Effects
– Nausea, vomiting – Black stools
Activated Charcoal
Administration
– Shake container thoroughly – Use covered opaque container – Have patient drink through straw – If patient vomits dose may be repeated
Syrup of Ipecac
Induces vomiting by irritating stomach and stimulating vomiting center in brainstem Seldom used anymore May be helpful if ingestion has occurred within last 30 minutes
Syrup of Ipecac
Dose
Children = 15 cc orally Adults = 30 cc orally
Repeat once after 20 minutes as needed Be sure patient has H20 in stomach Should not be given at same time as activated charcoal
Syrup of Ipecac
Contraindications
– Decreased level of consciousness – Seizing or has seized – Caustic poison (acids or alkalis) – Petroleum based products
Absorbed Poisons
Dry chemicals
– dust skin, then – wash
Liquid chemicals
– wash with large amounts of H20 – avoid “neutralizing” agents
CAUTION Don’t accidentally expose yourself!
Inhaled Poisons
Remove patient from exposure Maximize oxygenation, ventilation
CAUTION Don’t accidentally expose yourself!
Injected Poisons
Attempt to slow absorption
Venous constricting bands Dependent position Splinting of injected body part Cold packs (+) [May worsen local injury by concentrating poison]
Drug Abuse/Overdose
Substance Abuse
Self administration of a substance in a manner not in accord with approved medical or social practices
Substance Abuse
Psychological dependence Physical dependence Compulsive drug use Tolerance Addiction
Psychological Dependence
Habituation Substance needed to support user’s sense of well-being
Physical Dependence
Substance must be present in body to avoid physical symptoms (withdrawal)
Compulsive Drug Use
Use of drug and rituals/culture associated with its use become an overwhelming desire
Tolerance
Increasing amounts of drug needed to produce same effects Tolerance contributes to addiction by keeping user “chasing the last high”
Addiction
Combination of psychological dependence, physical dependence, compulsive use, and tolerance Patient becomes totally consumed with obtaining, using drug to exclusion of all other things
Ethyl Alcohol (EtOH)
Ethyl Alcohol
A CNS Depressant Drug
D e c re a s e d R e a c tio n T im e D e c re a s e d S o c ia l In h ib itio n s P o te n tia tio n o f O th e r C N S D e p re s s a n ts S lo w e d G I T ra c t A c tiv ity T o x ic O v e rd o s e In c re a s e d A c c id e n ta l T ra u m a R is k In c re a s e d In te n tio n a l T ra u m a R is k L e th a l O v e rd o s e s in C o m b in a tio n w ith O th e r D ru g s Irrita tio n , G a s tritis , U lc e r D is e a s e , G I B le e d s R e s p ira to ry D e p re s s io n , S h o c k
Ethanol Intoxication Signs
Breath odor Swaying, unsteadiness Slurred speech Nausea, vomiting Flushed face Drowsiness Violent, erratic behavior
Ethanol
Clouds signs, symptoms Complicates assessment Head trauma, diabetes, drug toxicity, CNS infection can mimic EtOH intoxication and vice versa
Patient is NEVER “just drunk” until all other possibilities are excluded
Alcohol Addicts
Experience alcohol withdrawal syndrome if they reduce intake:
Restlessness, tremulousness Hallucinations Seizures Delirium tremens--all of above plus tachycardia, nausea, vomiting, hypertension, elevated body temperature
Delirium Tremens
Life threatening condition! Occurs 1 days to 2 weeks after intake is decreased 5 to 15% mortality Control airway, prevent aspiration, monitor for hypovolemia
Narcotics
Opium Opium derivatives Synthetic compounds that produce opium-like effects
Narcotics
Opium Heroin Morphine Demerol Dilaudid
Percodan Codeine Darvon
Talwin
Narcotics
Medical Uses
– analgesics – anti-diarrheal agents – cough suppressants
Narcotics
Overdose
Coma Respiratory depression Constricted (pin-point) pupils
Narcotics
Withdrawal
– Agitation – Anxiety – Abdominal pain – Dilated pupils –Sweating –Chills –Joint pains –Goose flesh
Resembles severe influenza Not a life-threat
Barbiturates
Nembutal Seconal Pentobarbital Amytal Tuinal Phenobarbital
Barbiturates
Induce sleepiness, state similar to EtOH intoxication Medical uses
– Anesthetics – Sedative – Hypnotics
Barbiturates
Overdose
– Coma – Respiratory depression – Shock
Extremely dangerous in combination with EtOH
Barbiturates
Withdrawal
– Resembles EtOH withdrawal (DTs) – Extremely dangerous
Barbiturate-like Non-barbiturates
Doriden, Placidyl, Quaalude, Methyprylon Effects similar to barbiturates Overdose can cause sudden, very prolonged respiratory arrest Withdrawal resembles ETOH; extremely dangerous
Tranquilizers
Valium, Librium, Miltown, Equanil, Tranxene Low doses relieve anxiety, produce muscle relaxation High doses produce barbiturate-like effects
Tranquilizers
Overdose:
Unlikely to cause respiratory arrest alone Extremely dangerous with EtOH
Withdrawal
– Resembles EtOH withdrawal – Extremely dangerous
CNS Stimulants: Amphetamines
Dexedrine, Benzedrine, Methyl amphetamine Relieve fatigue, promote euphoria, reduce appetite
CNS Stimulants: Amphetamines
Overdose
– – – – Restlessness, paranoia Tachycardia Hypertension CVA, Heart failure Hyperthermia Heat stroke
Withdrawal
– Lethargy – Depression
CNS Stimulants: Cocaine
Stronger stimulant effects than amphetamines Can cause respiratory/cardiovascular failure, heat stroke, lethal arrhythmias
CNS Stimulants: Cocaine
“Snorting” can destroy nasal septum, cause massive nosebleed Withdrawal:
– lethargy – depression
Hallucinogens
LSD, psilocybin, peyote, mescaline, DMT, MDMA Enhance perception Wrong setting may induce “bad trips” with extreme anxiety True toxic overdose rare
Phencyclidine
PCP, angel dust Produces bizarre, violent behavior Reduces pain sensation Patients may be capable of feats of extreme strength Keep patient in quiet environment, minimize stimulatin
Solvents
Glue, paint, gas, light fluid, toluene Inhalation produces state similar to EtOH intoxication Patient may asphyxiate if consciousness lost while “sniffing”
Solvents
Increase risk of arrhythmias May cause liver damage, bone marrow depression Chronic abuse causes CNS damage - paranoia, violent behavior