Poison and Overdose

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Temple College
EMS Professions
   Substance which when introduced into
    body in relatively small amounts causes in
    structural damage or functional
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
   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
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
 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

    Don’t accidentally expose yourself!
Inhaled Poisons
 Remove patient from exposure
 Maximize oxygenation, ventilation

    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
Compulsive Drug Use
   Use of drug and rituals/culture
    associated with its use become an
    overwhelming desire
 Increasing amounts of drug needed
  to produce same effects
 Tolerance contributes to addiction by
  keeping user “chasing the last high”
 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
Decreased Reaction      Increased Accidental
Time                    Trauma Risk

Decreased Social        Increased Intentional
Inhibitions             Trauma Risk

Potentiation of Other   Lethal Overdoses in
CNS Depressants         Combination with Other
Slowed GI Tract         Irritation, Gastritis,
Activity                Ulcer Disease, GI
Toxic Overdose          Respiratory
                        Depression, Shock
Ethanol Intoxication Signs
   Breath odor
   Swaying, unsteadiness
   Slurred speech
   Nausea, vomiting
   Flushed face
   Drowsiness
   Violent, erratic behavior
 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
Alcohol Addicts
   Experience alcohol withdrawal syndrome
    if they reduce intake:
    Restlessness, tremulousness
    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
 Opium
 Opium derivatives

 Synthetic compounds that produce
  opium-like effects
 Opium      Percodan

 Heroin     Codeine

 Morphine   Darvon

 Demerol    Talwin

 Dilaudid

   Medical Uses
    – analgesics
    – anti-diarrheal agents
    – cough suppressants
   Overdose
    Respiratory depression
    Constricted (pin-point) pupils
   Withdrawal
    – Agitation          –Sweating
    – Anxiety            –Chills
    – Abdominal pain     –Joint pains
    – Dilated pupils     –Goose flesh

       Resembles severe influenza

            Not a life-threat
 Nembutal
 Seconal

 Pentobarbital

 Amytal

 Tuinal

 Phenobarbital
 Induce sleepiness, state similar to
  EtOH intoxication
 Medical uses
    – Anesthetics
    – Sedative
    – Hypnotics
   Overdose
    – Coma
    – Respiratory depression
    – Shock
   Extremely dangerous in combination
    with EtOH
   Withdrawal
    – Resembles EtOH withdrawal (DTs)
    – Extremely dangerous
Barbiturate-like Non-barbiturates

 Doriden, Placidyl, Quaalude,
 Effects similar to barbiturates

 Overdose can cause sudden, very
  prolonged respiratory arrest
 Withdrawal resembles ETOH;
  extremely dangerous
 Valium, Librium, Miltown, Equanil,
 Low doses relieve anxiety, produce
  muscle relaxation
 High doses produce barbiturate-like
   Overdose:
    Unlikely to cause respiratory arrest
    Extremely dangerous with EtOH
   Withdrawal
    – Resembles EtOH withdrawal
    – Extremely dangerous
CNS Stimulants: Amphetamines

 Dexedrine, Benzedrine, Methyl
 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
 Can cause respiratory/cardiovascular
  failure, heat stroke, lethal
CNS Stimulants: Cocaine
 “Snorting” can destroy nasal
  septum, cause massive nosebleed
 Withdrawal:
    – lethargy
    – depression
 LSD, psilocybin, peyote, mescaline,
 Enhance perception

 Wrong setting may induce “bad
  trips” with extreme anxiety
 True toxic overdose rare
 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
 Glue, paint, gas, light fluid, toluene
 Inhalation produces state similar to
  EtOH intoxication
 Patient may asphyxiate if
  consciousness lost while “sniffing”
 Increase risk of arrhythmias
 May cause liver damage, bone
  marrow depression
 Chronic abuse causes CNS damage
  - paranoia, violent behavior

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