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
Anticholinergics
Examples
S/S
Treatment
Ex- Antihistamines, Atropine, Antipsychotics, Antidepressants
S/S- HR/\, Delirium, DILATED pupils, Flushed skin, Dysrhythmias, Seizures
Treatment
- Valium
- Activated charcoal
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
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
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
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)
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
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
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
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
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
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)
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
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
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)
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
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
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)
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
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
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
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
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
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
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
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
Indications of a meth lab (7)
- Funnels/Containers/Tubing
- Large tanks
- OTC meds
- Vehicle fluids
- Thinners
- Filters
- Foils
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
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
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
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
What medication comes from the Foxglove plant
Digoxin
What plant produces Ricin
Castor bean
Poisonous Mushrooms and Plants
S/S
Treatment
S/S
- SLUDGEM
- Abd cramps, Nv, Diarrhea
- Decreasing LOC, Coma
Treatment
- Supportive
- Contact PCC
What is Hymenoptera
Large class of insects consisting of Bees, Wasps, Hornets, Ants
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
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
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
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
Venomous vs Nonvenomous snakes
Eyes
Pits
Fangs
Venomous
- Elliptical eyes
- Pits behind eyes
- Fangs
Nonvenomous
- Round eyes
- No pits behind eyes
- No fangs
3 venomous snakes that inhabit ohio
- Timber rattlesnake
- Northern copperhead
- Eastern massasauga
Timber Rattlesnake
Information
- Pits behind eyes
- Very dark camo
- Flee when scared
- Lives in the woods
- Rattles after they strike
Northern Copperhead
Information
- Copper color
- Use tail to catch prey
- Live in woods, swamps, meadows, mountains
Eastern Massasauga
Information
- Very spotted very dark brown and tan
- Lives in swamps
- Go away from noise
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
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
Index of suspicion for drug abuse (3)
- Unusual behavior
- Track marks
- Paraphenalia
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