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Sinclair Paramedic 2150 > 10- Toxicology > Flashcards

10- Toxicology Flashcards

1
Q

What is toxicology

A

The study of poisons and their antidotes

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2
Q

What age group is most likely to be poisoned

A

1-2 y/o

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3
Q

What age group dies the most form poisons

A

20-60 y/o

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4
Q

Do males or females die more from poisons

A

Females

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5
Q

What is ingestion (Poisons)

A
  • Through GI tract
  • Immediate or delayed effects
  • May damage mouth, throat, esophagus immediately
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6
Q

What is inhalation (Poisons)

A
  • 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
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7
Q

What is injection (Poisons)

A
  • Pierce skin into dermal, subcu, IM, IV routes

- Time to circulatory system depends on the route

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8
Q

What is absorption (Poisons)

A
  • Through the bodies surface

- Slow and unpredictable

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9
Q

What is the most common poisoning route and most fatal

A

INGESTION

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10
Q

What is the number for the National Poison Control Center

A

1-800-222-1222

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11
Q

What is the role of the poison control center for EMS

A

Trained personnel with reference material on all types of poisoning.
Can provide expected effects, recommended care, additional info

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12
Q

7 principles of toxicological management

A
  1. Survey scene
  2. Ensure scene safety
  3. Route of exposure
  4. ABC’s
  5. Limit absorption
  6. Enhance elimination
  7. Administer antidote
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13
Q

7 pieces of information you need to gather for toxicological emergencies

A
  1. What was the substance
  2. What time did the exposure happen
  3. How much exposure was there
  4. How long of an exposure was there, length of time to put in body
  5. What interventions were done
  6. Patients weight
  7. Current side effects
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14
Q

What is the purpose of dilution for poisoning

A

Water intake to slow absorption slightly

Adults- 1 to 2 glasses
Peds- 1/2 to 1 glass

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15
Q

What are the 3 most common poison exposure types

In order

A
  1. Analgesics
  2. Cleaning substances
  3. Cosmetics
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16
Q

What are the top 3 killer types of poisons

In order

A
  1. Analgesics
  2. Sedatives
  3. Cleaning substances
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17
Q

4 most common medication errors

In order

A
  1. Inadvertently took multiple doses
  2. Incorrect dose
  3. Incorrect medication
  4. Given someone else’s medication
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18
Q

What are toxidromes

A
  • Similar agents with similar physical findings

- Easier to remember assessment and management strategies

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19
Q

What are the 6 toxidromes

A
  • Stimulants
  • Narcotics
  • Sympathomimetics
  • Sedatives
  • Cholinergics
  • Anticholinergics
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20
Q 
Injected poisons key points (2)
General treatment (8)
A
  • 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
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21
Q

Ingested poisons key points (3)

A
  • Usually from contaminated food and poisonous plants
  • Contact poison control
  • Induce vomiting if <20 min, know about, conscious, cleared though PCC
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22
Q

Inhaled Poisons

  • Presentation of Resp, CNS, CV systems (8, 6, 1)
  • General Treatment (7)
A 
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
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23
Q

Surfaced Absorbed Poisons
Info
General management (6)

A

Usually organophosphates or cyanide

Management

  • Remove patient
  • PPE, SCBA
  • ABC’s
  • PA, SA
  • O2
  • Contact PCC
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24
Q

Commonly Drugs of Abuse (10)

A
  • Barbituates
  • Cocaine
  • Narcotics
  • Marijuana
  • Amphetamines
  • Hallucinogens
  • Benzodiazepines
  • Date Rape drugs
  • Alcohol
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25
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
26
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
27
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
28
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
29
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
30
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
31
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
32
Anticholinergics Examples S/S Treatment
Ex- Antihistamines, Atropine, Antipsychotics, Antidepressants S/S- HR/\, Delirium, DILATED pupils, Flushed skin, Dysrhythmias, Seizures Treatment - Valium - Activated charcoal
33
Cholinergics Examples S/S Treatment (ANTIDOTE)
Ex- Organophosphates, Nerve agents, Insectisides, Carbamate, Some mushrooms S/S- SLUDGEM, Constricted pupils, HR\/, CNS\/, Weak Treatment - ANTIDOTE Atropine - Pralidoxime (2Pam, Duodote) - Valium - Activated charcoal
34
Opioids Examples (6) S/S (8) Treatment (3) (ANTIDOTE)
Ex- Heroin, Morphine, Codeine, Meperidine, Fentanyl, Popoxyphene S/S- CNS\/, BP\/, RR\/, HR\/, CONSTRICTED PUPILS, Euphoria, Seizures, Coma Treatment - Airway support - IV - ANTIDOTE Narcan .4-2 mg IV
35
Sedatives/Hypnotics Examples S/S Treatment
Ex- Barbituates and Benzos- Valium, Xanax, Librium, Phenobarbital S/S- CNS\/, BP\/, HR\/, RR\/, Ataxia, Nystagmus Treatment - ABC’s - IV - ECG - Romazicon (Flumazenil) - Support vitals
36
Sympathomimetic Examples S/S Treatment
Ex- Cocaine, Crack, Amphetamine, Methamphetamines, OTC decongestants S/S- HR/\, BP/\, Temp/\, Delusions, Seizures Treatment - Diazepam 2-4mg (preseizure) - Decrease stimulation - Aggressive cooling (Hyperthermia) - Beta blockers (Tachy-dysrhythmias)
37
Hallucinogens Ex S/S Treatment
Ex- LSD, Ecstasy (MDMA), Peyote and Mescaline, Certain mushrooms, Ketamine, Phencyclidine (PCP) S/S- Altered perceptions, H/A, NV, Psychosis, Hallucinations, CNS depression Treatment - Supportive - Valium - Keep patient calm
38
``` Acetaminophen Drug Class Examples S/S Treatment (ANTIDOTE) Notes ```
Drug Class: NSAID Ex. Tylenol, Pandol S/S 0-72 hrs- NV, Pallor, Diaphoresis, Fatigue, Weakness, RUQ pain 3 to 14 days- Severe liver damage, Jaundice, renal failure, metabolic acidosis Treatment - Supportive - Activated charcoal - ANTIDOTE Mucomyst (N-acetylcysteine) Notes- There are 4 stages of toxicity, >150mg/kg s toxic
39
``` Amphetamines Drug Class Examples S/S Treatment ```
Drug Class: STIMULANT Ex- Ritalin, Speed, Meth, Benzedrine, Dexedrine S/S- HR/\, BP/\, RR/\ Treatment - Adenosine (SVT) - Valium
40
``` Bath Salts Drug Class Examples S/S Treatment ```
Drug Class: STIMULANT Ex. MDPV, Mephedrone S/S- HR, RR, BP UP, diaphoresis, agitation Treatment - Benzos - Antipsychotics *Same S/S regardless of route
41
``` Beta Blockers Drug Class Examples S/S Treatment ```
Drug Class: Cardiovascular agent Ex- Atenolol, Propranolol, Metoprolol, Labetalol, Sotalol S/S- Brady C, HypoT, Resp depression, HypoG, AV blocks/Wide QRS, Seizures Treatment Fluids (Pressors; Dopamine/Epi drip) Glucagon 1mg every 5min Calcium Gluconate/Chloride
42
``` Calcium Channel Blockers Drug Class Examples S/S Treatment (ANTIDOTE) ```
Drug Class: Cardiovascular agent Ex- Diltiazem, Nifedipine, Verapamil, Amlodipine S/S- BradyC, HypoT, Impaired conduction, NV, Sudden shock/CA Treatment - ANTIDOTE Calcium Chloride/Gluconate - Fluids (Pressors; Dopamine/Epi drip) - Glucagon 1mg every 5min - Pacing (Not for w/ Dig)
43
Carbon Monoxide Example S/S Treatment (ANTIDOTE)
Ex- Byproduct of incomplete combustion S/S- NV, Ha, Confusion, Flu like, RR up, AMS Treatment - Remove patient - ANTIDOTE High flow O2 - IV - ECG
44
Caustics Examples (Acids and Bases) S/S Treatment
Ex - Acids - Hydrochloric acid, Sulfuric acid, Bleach disinfectants - Bases - Lye (Na or K hydroxide), Na Hypochlorite, Na Carbonate, Ammonia, K permanganate S/S- Painful mouth/Facial burns, Resp distress, Hemorrhage, Drooling, Shock Treatment - ABC’s - IV - Decon - DO NOT induce vomitig
45
``` Cocaine Drug Class Action S/S Treatment ```
Drug Class: Stimulant Action- Enhance release of Epi, Dopamine, Serotonin S/S- HR, RR, BP up, Dysrhythmias, SOB, Diaphoresis Treatment - Adenosine (SVT) - Valium (Premedicate for seizures)
46
Cyanide Sources S/S Treatment (ANTIDOTE)
Sources- Burned plastics, fruit pits, Nipride, Manufacturing *Colorless with bitter almond smell S/S- Burning sensation, Combative, HyperT, TachyC, TachyP, pulmonary edema Treatment ANTIDOTE- Hydroxycobalamin 5g/15 min
47
``` Digoxin Drug Class Examples S/S Treatment (ANTIDOTE) ```
Drug Class: Digitalis glycosides (Improve hearts ability, Control rate) Ex- Digitoxin, Lanoxin, Digoxin, Nipride S/S- Halo around objects in sight, Abd pain, NV, HyperK, Heart blocks and ventricular ectopy, BradyC ``` Treatment ANTIDOTE- DIGIBIND -Atropine (BradyC) -Shock 25 to 200J (VTach) -Mag Sulfate (VFib) -IV, Monitor -Calcium Gluconate ```
48
Hydrocarbons Examples S/S Treatment
Ex- Gas, Kerosine, Mineral oil, Toluene, Terpentine, Aerosol propellants, Methane, Butane S/S- TachyC, Decreased LOC, Ataxia, Dysrhythmias, H/a, N/V, Dyspnea Treatment - Decon - ABC’s - O2, greater than 94% - IV, Monitor - Fluid (HypoT)
49
``` Hydrofluoric acid/Hydrogen fluoride Examples Action S/S Treatment (ANTIDOTE) ```
Examples- Product to remove impurities in industries Action- HypoCa, HypoMag, HyperK in circulation S/S- HypoT, Dysrhythmias, Resp arrest, Burning/Itching, Acidemia, CNS depression, Tissue necrosis, Abd pain, NV Treatment - Remove and Decon - 10% Calcium Gluconate paste on burns - HypoT, Dysrhythmias - Calcium chloride/gluconate - Vasopressors - Magnesium
50
Lithium Uses S/S Treatment
Used to treat depression S/S- Weakness, Ataxia, Blurred vision, Confusion, Seizure, Coma, Apnea, Heart blocks Treatment - ABC’s - O2 - IV, ECG
51
``` MAO Inhibitors Drug Class Examples Action S/S Treatment ```
Drug Class: Antidepressant Action- Removes NorEpi, Serotonin, Dopamine as neurotransmitters Examples- Nardil(Phenelzine), Marplan, Parnate (Tranylcypromine) S/S- CNS depression, HyperT, TachyC, CP, Diaphoresis, Resp depression, Delirium, Seizures Treatment - ABC’s - High flow O2 - IV, ECG - Antidysrhythmics - Benzos - Vasopressors - Active cooling
52
``` Non-Steroidal Anti-Inflammatory Drugs Examples S/S Treatment Unique Note ```
Ex- Ibuprofen, Keteolac, Naproxin Sodium S/S- NV, Abd pain, Metabolic acidosis, Dyspnea, Pulmonary edema, Extremity swelling, Tinnitus Treatment - ABC’s - Supportive Note- Adverse effect is aseptic meningitis; Stiff neck, Ha, Fever - Discontinue use and transport
53
Salicylates Examples S/S Treatment
Ex-Aspirin, Oil of Wintergreen S/S- TachyC, Dysrhythmias, Abd pain, Acidosis, Lethargy, HyperTherm, Pulmonary edema, ARDS Treatment - IV, O2, Monitor - IV glucose - Sodium Bicarb - Activated charcoal
54
``` Selective Serotonin Reuptake Inhibitor (SSRI) Action Examples S/S Treatment ```
Action- Inhibit serotonin breakdown Ex- Paxil (Fluoxetine), Zoloft (Sertraline), Prozac (Peroxetine), Celexa S/S- NV, Tremors, Dilated pupils, Hypo/HyperT, Seizures, Prolonged QTI Treatment - ABC’s - IV, ECG - Sodium Bicarb for widening QRS CMC first
55
Tricyclics Anti-Depressants Examples S/S Treatment
Ex- Amitriptyline (Amitril, Elavil), Imipramine (Apo-Imipramine), Doxepin S/S- (Sympathomimetic/Serotonergic Effects) - TachyC, TachyP, HypoT, HyperTherm, Dilated pupils, Dysrhythmias, AMS, Seizures Treatment - Support - O2, IV, Monitor - Bicarb for Dysrhythmias - BGL - NO FLUMAZENIL - Benzos for seizures
56
``` Theophylline Drug Class Examples S/S Treatment ```
Drug Class: Methylxanthine Ex- Aminophylline, Slo-Bid, Theo sprinkles S/S- TachyC, Arrythmias, HypoT, TachyP, Seizures, Nv Treatment - Supportive - Sodium Bicarb after CMC - Activated charcoal after CMC
57
Indications of a meth lab (7)
- Funnels/Containers/Tubing - Large tanks - OTC meds - Vehicle fluids - Thinners - Filters - Foils
58
Lead poisoning S/S Treatment
S/S- Destruction of gastric mucosa leading to hemorrhage, Hematemesis, Melena, Eventual cardiovascular collapse, Encephalopathy, Developmental delays Treatment - IV, O2, Monitor - Fluids with caution to avoid worsening Encephalopathy
59
Mercury Poisoning S/S Treatment
S/S-Lipid soluble, AMS, Excitability, Vision impairment, Renal failure, Tremors, Ataxia, Excessive drooling, ABD pain Treatment - Decon - ABC’S - Supportive
60
Arsenic Poisoning S/S Treatment
S/S-Severe abd pain, HypoT, Nausea, Explosive diarrhea, Metallic taste in mouth, Rhabdo, Dysrhythmias Treatment - ABC’s - High flow O2 - Fluid (Vasopressors if needed) - ECG, IV, Monitor
61
Contaminated food poisoning Examples S/S Treatment
Ex-Botulism, Salmonella, E Coli, Shigella S/S- Nv, Diarrhea, Abd pain, Facial flushing, Resp distress, Cramping Treatment - ABC’s - IV - Antiemetics - Fluid
62
What medication comes from the Foxglove plant
Digoxin
63
What plant produces Ricin
Castor bean
64
Poisonous Mushrooms and Plants S/S Treatment
S/S - SLUDGEM - Abd cramps, Nv, Diarrhea - Decreasing LOC, Coma Treatment - Supportive - Contact PCC
65
What is Hymenoptera
Large class of insects consisting of Bees, Wasps, Hornets, Ants
66
Hymenoptera S/S Treatment
S/S -Localized pain and swelling, redness, anaphylaxis Treatment - Wash area - Remove stinger (scrape it off) - Cool compress - Observe and treat anaphylaxis
67
Brown Recluse Info S/S Treatment
Info -Violin shape on back, Tissue necrotic venom, found in southern and Midwest states S/S- Small bleb with white halo, Redness, Swelling, Joint pain, Fever, Chills, Nv Treatment - Supportive - Prevent anaphylaxis with Antihistamines
68
Black Widow Info S/S Treatment
Info - Found everywhere - Orange/Red hour glass on abdomen - Neurotoxin S/S- Pain, Redness, Progressive muscle spasms, Sever back/chest/shoulder pain, Abd pain, Nv, Diaphoresis, Seizures, HyperT, Paralysis, ALOC, HyperT Treatment - Supportive - Calcium Gluconate/Valium for seizures - Antivenin
69
Scorpion Stings Info S/S Treatment
Info - Effects Cardiac and Resp centers through CNS - Venom is in bulb on tip of tail S/S- Burning/Tingling, Pain then numbness, Muscle twitching, Abd cramps, Nv, Seizures, Ataxia, Blurred vision
70
Venomous vs Nonvenomous snakes Eyes Pits Fangs
Venomous - Elliptical eyes - Pits behind eyes - Fangs Nonvenomous - Round eyes - No pits behind eyes - No fangs
71
3 venomous snakes that inhabit ohio
- Timber rattlesnake - Northern copperhead - Eastern massasauga
72
Timber Rattlesnake | Information
- Pits behind eyes - Very dark camo - Flee when scared - Lives in the woods - Rattles after they strike
73
Northern Copperhead | Information
- Copper color - Use tail to catch prey - Live in woods, swamps, meadows, mountains
74
Eastern Massasauga | Information
- Very spotted very dark brown and tan - Lives in swamps - Go away from noise
75
Pit Vipers Common incident S/S Treatment
Incident- Drunks playing with snakes S/S- Hemmorhage, Nv, Weak, Resp depression, Numb/Tingling face and head Treatment - Supine - Immobilize area - NO ice, NO restrictive bands
76
``` Coral Snakes Color code Toxin type S/S Treatment ```
Color code- Red on yellow kill a fellow Toxin type- Neurotoxin S/S- ALOC, HypoT, Resp depression, Paralysis, Ataxia, Slurred speech, Seizures Treatment - Wash wound - Wound at heart level - Constricting band - IV
77
Index of suspicion for drug abuse (3)
- Unusual behavior - Track marks - Paraphenalia
78
``` Date Rape drugs Types Action S/S Treatment ```
Types- Gammahydroxybutyrate (GHB), Flunitrazepan (Rohypnol), Ecstacy (MDMA) Action GHB- Disinhibition and severe passivity Roophy- CNS depressant S/S Ecstasy- Upper GHB/Roophies- Downer (Sedation/Amnesia) Treatment - Narcan - Flumazenil

Sinclair Paramedic 2150 (16 decks)

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