10- Toxicology Flashcards
What is toxicology
The study of poisons and their antidotes
What age group is most likely to be poisoned
1-2 y/o
What age group dies the most form poisons
20-60 y/o
Do males or females die more from poisons
Females
What is ingestion (Poisons)
- Through GI tract
- Immediate or delayed effects
- May damage mouth, throat, esophagus immediately
What is inhalation (Poisons)
- In through respiratory tract
- Rapid absorption through alveolar-capillary membrane
- Can result in airway burns
- Can combine with tissue fluids to form corrosive chemicals
- Can cause widespread systemic effects
What is injection (Poisons)
- Pierce skin into dermal, subcu, IM, IV routes
- Time to circulatory system depends on the route
What is absorption (Poisons)
- Through the bodies surface
- Slow and unpredictable
What is the most common poisoning route and most fatal
INGESTION
What is the number for the National Poison Control Center
1-800-222-1222
What is the role of the poison control center for EMS
Trained personnel with reference material on all types of poisoning.
Can provide expected effects, recommended care, additional info
7 principles of toxicological management
- Survey scene
- Ensure scene safety
- Route of exposure
- ABC’s
- Limit absorption
- Enhance elimination
- Administer antidote
7 pieces of information you need to gather for toxicological emergencies
- What was the substance
- What time did the exposure happen
- How much exposure was there
- How long of an exposure was there, length of time to put in body
- What interventions were done
- Patients weight
- Current side effects
What is the purpose of dilution for poisoning
Water intake to slow absorption slightly
Adults- 1 to 2 glasses
Peds- 1/2 to 1 glass
What are the 3 most common poison exposure types
In order
- Analgesics
- Cleaning substances
- Cosmetics
What are the top 3 killer types of poisons
In order
- Analgesics
- Sedatives
- Cleaning substances
4 most common medication errors
In order
- Inadvertently took multiple doses
- Incorrect dose
- Incorrect medication
- Given someone else’s medication
What are toxidromes
- Similar agents with similar physical findings
- Easier to remember assessment and management strategies
What are the 6 toxidromes
- Stimulants
- Narcotics
- Sympathomimetics
- Sedatives
- Cholinergics
- Anticholinergics
Injected poisons key points (2) General treatment (8)
- Accidental or deliberate overdose
- Include bites or stings from land and sea creatures
General principles of treatment
- Scene safety
- Remove patient from danger
- Identify insect, reptile, animal if possible
- Perform PA and SA
- Prevent/delay poison absorption
- Watch for anaphylactic reaction
- Transport
- Contact poison control
Ingested poisons key points (3)
- Usually from contaminated food and poisonous plants
- Contact poison control
- Induce vomiting if <20 min, know about, conscious, cleared though PCC
Inhaled Poisons
- Presentation of Resp, CNS, CV systems (8, 6, 1)
- General Treatment (7)
S/S
-Resp
- TachyRR, Stridor, Cough, Wheezing, CP/Tightness,
Retractions, Rhonchi, Crackles
-Central Nervous System
- Dizzy, Confusion, Headache, Seizures, Hallucinations, Coma
- Cardiovascular
- Dysrhythmias
General Treatment
- Remove patient
- Consider pt breathing off poisonous fumes
- Decon
- SCBA, PPE
- ABC’s
- O2
- Contact PCC
Surfaced Absorbed Poisons
Info
General management (6)
Usually organophosphates or cyanide
Management
- Remove patient
- PPE, SCBA
- ABC’s
- PA, SA
- O2
- Contact PCC
Commonly Drugs of Abuse (10)
- Barbituates
- Cocaine
- Narcotics
- Marijuana
- Amphetamines
- Hallucinogens
- Benzodiazepines
- Date Rape drugs
- Alcohol
Alcohol
Action (3)
S/S (5)
Treatment (5)
Action- Depresses CNS to the point of of stupor, coma, death, crosses blood brain barrier, metabolizes at a steady rate
S/S- Altered decision making, resp depression, aspiration, possibly unconscious
Treatment
- O2
- IV
- ECG
- BGL
- Thiamine 100mg avoid WKS
General Alcoholic profile
Activity (3)
Physical findings (4)
History (2)
Activity: Drinks early in day, alone, secretly, binge drinks
Physical: Chronic flushing of face and palms, “green tongue syndrome”, odor on body/breath, cigarette burn on clothes
History: Unexplained GI problems, partial/total loss of memory during drinking
Consequences of chronic alcoholism (10)
- Poor nutrition
- Alcohol hepatitis
- Liver cirrhosis
- Loss of peripheral sensation
- Loss of balance/coordination
- Pancreatitis
- Upper GI bleeding
- Hypoglycemia
- Subdural hematoma from falls
- Rib and extremity fractures
Alcohol withdraw syndrome
Info (4)
S/S (12)
Treatment (4)
Info: Can occur at sudden abstinence, can last 5-7 days, seizures within 6-48 hrs after stoppage
- DTs can develop on 2nd or 3rd day
- DTs and seizures cause high mortality
S/S
- Coarse tremor of hands, tongue, eyelids
- NV, Weak, Diaphoresis, Anxiety, Hallucinations, poor sleep
- TachyC, HyperT, Ortho HypoT
Treatment
- ABC’S
- IV
- D50 25 g for HypoG
- Thiamine 100mg for malnutrition
Wernike-Korsakoff Syndrome
Explain
S/S
Treatment
Develops over time in chronic alcoholics due to chronic Thiamine (B1) deficiency
S/S
- After D50 admin*
- Stupor
- Comatose
- Seizure
Treatment
1st- Thiamine 100mg
2nd- D50 25mg
Alcohol Withdraw Seizures (Rum fits)
Information (3)
Treatment
Information
- 12-48hrs after drinking stops peak 13-24hrs
- Focal or Generalized
- Usually Grand mal and short duration
Treatment
-Valium 5mg every 5min 30mg max
Delirium Tremens (DTs)
Information
S/S
Treatment
Information- Most dramatic and serious form of alcohol withdraw. 72-96hrs up to 10-14 days after drinking stops.
S/S
- Coarse tremor of hands, tongue, eyelids
- Nv, Weakness, Anxiety
- TachyC, Hyper/HypoT, Hallucination, Diaphoresis, Ortho HypoT
Treatment
- Supportive
- Saline for HypoT
