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Paramedic > 118 Mod 3 (Toxicology and Behavioral Emer) > Flashcards

118 Mod 3 (Toxicology and Behavioral Emer) Flashcards

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1
Q

Overt Behavior

A

open and generally understood

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2
Q

Covert Behavior

A

have hidden meanings or intentions that only that person understands

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3
Q

Behavioral Emergency vs

Psychiatric Emergency

A

Behavioral - behavior that interferes with daily living activity

Psych - when it threatens a person health and safety (or another persons)

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4
Q

Delusions vs Hallucinations

A

Delusions - false beliefs

Hallucinations - sense perceptions not found on objective reality

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5
Q

If a patient refuses to engage with you…

A

continue to talk with them about the situation, explain your responsiblities

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6
Q

What are 4 causes of abnormal behavior

A

1 - biologic or organic
2 - environment
3 - acute injury, illness
4 - substance- related

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7
Q

Psychiatric Signs vs Symptoms

A

Symptoms - the effects of the abnormalities and corrective measures

Signs - Observing the effects

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8
Q

Define Affect

A

The outward expression of a person’s inner feelings

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9
Q

Define Stereotyped movements

A

Repetition of movement that dont seem to have purpose

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10
Q

Define Compulsions

A

Repetitive actions to relieve anxiety of obsessive thoughts

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11
Q

Define Pressure of Speech

A

pouring out of words like water escaping under pressure

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12
Q

Define Neologisms

A

words the patient invents

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13
Q

Define Echolalia

A

patient echoes words he or she hears

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14
Q

Define Mutism

A

Patient doesnt speak at all

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15
Q

Define Flight of Ideas

A

Fast thinking but skipping from one thought to the next

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16
Q

Define Confabulation

A

Inventing things to fill gaps in memory

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17
Q

Define Circumstantial thinking

A

Inclusion of many irrelevant details

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18
Q

Define Perseveration

A

repetition of the same idea over and over again

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19
Q

Define Inappropriate affect

A

emotion out of sync with situation

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20
Q

Define Flat affect

A

absence of emotion

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21
Q

Define Catatonic

A

Lacking expression or movement, appearing rigid

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22
Q

Constricted Pupils vs
Unequal pupils

A

Constricted - opiate ingestion

Unequal - cerebral trauma

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23
Q

Define MSE COASTMAP

A

C - consciousness (attentive)
O - orientation (year, location)
A - Activity (sitting still)
S - Speak (speaking clear)
T - Thought (making sense)
M - Memory - (remembers)
A - Affect/Mood (is appropriate)
P - Perception (awareness)

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24
Q

Signs Organic causes

A

part of the secondary assessment

Fever, intracranial pressure, skin temp, tattoos, scars, trauma, pupils, breath odors, needle tracks, tremors, loss of sensation

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25
Q

Define Confrontations

A

Directing the patients attention to something they might not have noticed without sounding condescending or judging

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26
Q

Things you should do when talking to patient

A

Ask open non leading questions

Sit 45 degree across

Don’t give patient choices, state best action

Observe the patient at all times (never alone)

Stay between patient and exit

Let patient do things for themself

Bring all meds to hospital

Assume patient can hear everything, explain everything

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27
Q

How many people does it take to restrain a patient

A

5 trained - one at head, one at each limb

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28
Q

When restraining patient

A

avoid injury, give option of non violence

Remove any equipment or jewelry from your own body that could be used as a weapon (eg, name badge, scissors worn on the belt, key chain, earrings).

Secure Supine, with head turned to side

Never tie ankle and wrist together

Do not make deals

Monitor ABC, CMS

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29
Q

What is a two point restraint

A

one arm is placed upward toward the head and the other is placed downward toward the waist.

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30
Q

Define Psychosis

A

A state of delusion in which a person is out of touch with reality

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31
Q

When should you give Chemical Restraint

A

After verbal attempts

and with approval from medical control (following protocols)

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32
Q

What are most common chemical restraints

A

benzodiazepines, antipsychotics, dissociative agents, and antihistamines

(black box warning - serious adverse effects)

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33
Q

Name some Benzos

A

Diazepam (valium) - IV
Lorazepam (Ativan) - IM/IV
Midazolam (Versed) - IM/IV,IN (short acting)

can be for ped or adult

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34
Q

Define Ataxia

A

Impaired balance or coordination

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35
Q

Name some Antipsychotics

A

Droperidol (inapsine)
Haloperidol (Haldol)
Ziprasidone (Geodon)

  • black box warning for Droperidol cause prolonged QT, caution with electrolye imbalance
  • High doses of Haldol and IV -cause prolonged QT and torsades de pointes. Do not give haldol under 14, or head trauma, or pregnant, not approved for dementia, caution with electrolye imbalance

Monitor with ECG
May cause seizures (extra pyramidal symptoms)

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36
Q

Name the newer Antipsychotics

A

Olanzapine (Zyprexa)
Ziprasidone

(may have fewer extra pyramidal symptoms)

monitor for hypotension, bradycardia, BGL

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37
Q

What is recommended for ped patients

A

Droperidol

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38
Q

What combination should you avoid in older dementia patients

A

parenteral olanzapine and a
benzodiazepine to the same patient

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39
Q

Is Ketamine used to chemically restrain patients?

A

Ketamine - N-methyl-D-aspartate
receptor antagonist

is used for sedation but has complications

not approved by the FDA

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40
Q

Name antihistamine used

A

Diphenhydramine (Benadryl)

used for sedation

produces anticholinergic effect in brain

used for both adult and peds

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41
Q

Define Acute Psychosis

A

person is out of touch with reality (voices feelings within)
hyper, stereotyped movement,

many causes both organic and biologic, common cause mind altering drugs.

other causes - stress, disorders, schizophrenia

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42
Q

When dealing with a violent patient

A

Do not turn your back on the patient

Maintain a safety zone of two arms lengths

Stand slightly to the side at 45 degrees with escape route unobstructed

Note any possible weapons

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43
Q

Define Unipolar Mood Disorder

A

Patients who experience either depression or mania

mood remains at only one side

unipolar mania is rare

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44
Q

Define BiPolar Mood Disorder

A

Alternating between mania and depression (both sides)

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45
Q

Define Mania (Manic Behavior)

A

Having exaggerated perception of joy with hyperactivity and insomnia. My have hallucinations.

unable to concentrate

rapid speech, rapid thoughts

tangential thinking - skipping topics

may become hostile.

Be calm, firm, talk away from others. consult medical control if needed.

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46
Q

Tangential thinking vs Circumstantial thinking

A

Tangential - rapid skipping topics

Circumstantial - including many irrelevant details

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47
Q

Define Depression

A

can be sudden or subtle in onset and chronic in nature.

dysthymic disorder - chronic form of depression, most days over atleast 2 years.

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48
Q

Mnemonic for depression

A

GAS PIPES

G - Guilt
A - Appetite
S - Sleep

P - Paying attention
I - Interest
P - Psychomotor abnormal
E - Energy
S - Suicidal thoughts

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49
Q

Define Schizophrenia

A

A mental disorder usually onset during early adulthood.

delusions, hallucinations, apathy, mutism, flat affect, lack of interest in pleasure, erratic speech, dysfunctional emotional responses, and dysfunctional motor behavior.

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50
Q

Define Neurotic disorder

A

several disorders without psychotic symptoms.

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51
Q

Define anxiety disorder

A

patients experience persistent, incapacitating anxiety in the absence of external threat.

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52
Q

Define Generalized Anxiety Disorder

A

A diagnosis of GAD requires that symptoms (anxiety and worry) must be present more days than not for a period of at least 6 months, and the worry must be difficult to turn off or control.

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53
Q

Define Phobic Disorder

A

Fear of a specific situation or thing.

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54
Q

Define Simple phobia`

A

patient focuses all anxieties onto one class of objects or situation.

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55
Q

Define Panic Disorder

A

sudden, usually unexpected, and overwhelming. feelings of fear. Attacks usually begin in 20s.

Massive activation of the autonomic nervous system.

palpitation and sweating, hyperventilation

peak 10 mins last up to an hour

seperate from public, calm, safe

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56
Q

Define Agoraphobia

A

Fear of public places

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57
Q

4 Levels of substance related disorders

A

Moderate

Substance intoxication - use causes impaired thinking/motor

Substance Abuse - disrupts ADLs

Substance Dependence - needs more and more

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58
Q

Bulimia vs Anorexia

A

bulimia - binging then puriging food

anorexia - lose so much weight, jeopardize health. fear of obesity while being underweight. May have amenorrhea (absence of menstruation)

both could have severe electrolyte imbalance leading to cardiac, seizures, renal failure, etc.

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59
Q

Define Somatoform Disorder

A

overly concerned with physical health and appearance.

hypochondriasis is a classic example, patients have extreme anxiety or fear that they may have a serious disease. Imagined symptoms

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60
Q

Define Conversion disorder

A

physical condition (eg, paralysis, blindness, or seizures) has no identifiable pathophysiology but results from malingering or faking a physical disorder.

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61
Q

Define Factitious Disorder

A

Aka Münchausen syndrome, is a condition in which a person intentionally produces or feigns physical or psychological signs or symptoms. In such cases, the patient wishes to be sick.

by proxy - parent faking child sickness

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62
Q

Define Impulse control disorder

A

Examples include intermittent explosive disorder, kleptomania, pyromania, and pathologic gambling.

Typically associated with other disorders depression, alzheimers

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63
Q

Define Personality disorders

A

When these ways of relating to others become dysfunctional or cause distress to other people, that person is considered to have a personality disorder.

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64
Q

Name types of Psychiatric Meds

A

Antidepressants
Benzodiazepines
Antipsychotics
Amphetamines

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65
Q

Name 4 types of Antidepressants

A

SSRI - selective reuptake inhibitors - also used for panic/anxiety disorders

SNRI - serotonin-norepinephrine reuptake

tricyclic antidepressants (TCAs),

monoamine oxidase inhibitors (MAOIs).

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66
Q

What is a common antidepressants

A

Citalopram (Celexa) - SSRI

SSRI lack the anticholinergic, and cardiac effects of other antidepressants

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67
Q

Benzos contraindication

A

Allergic
Narrow angle gaucoma
Pregnancy

Have long half lives and can cause sedation, confusion in older patients

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68
Q

Name two common Benzos

A

Diazepam (Valium)
Lorazepam (Ativan)

may be prescribed for emotional distress, panic, anxiety, seizures, muscle relaxation

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69
Q

Define AntiPsychotic Drugs

A

Neuroleptics - neurologic function meds

Newer - AAP - atypical anti -psychotic drugs (seroquel, zyprexa)

order - typical antipsychotic drugs (prolixin, thorazine)

relieve delusions, hallucinations

side effects - glucose dereg, hypertension, ecg changes

Phenothiazines - HALOPERIDOL - ecg changes

May have Anticholinergic effects - drymouth, urinary retention, etc

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70
Q

Define Acute Dystonic Reaction

A

patient develops muscle spasms of the neck, face, and back within a few days of starting treatment with antipsychotic meds.

You can rapidly correct an acute dystonic reaction by giving diphenhydramine (Benadryl), 25 to 50 mg IV.

However, the muscle spasms are likely to recur after the diphenhydramine wears off.

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71
Q

Define Amphetamines

A

Are Central Nervous and parasympathetic stimulants
stimulants similar to other sympathomimetic medications (eg, epi)

Amphetamines (eg, Adderall) are prescribed to help with attention deficit disorder with hyperactivity.

may raise both systolic and diastolic blood pressure while often slowing the pulse rate. Cardiac dysrhythmias may occur with large doses.

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72
Q

What meds are good for aggression

A

Benzodiazepines and antipsychotics

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73
Q

What are the 2 most frequent diagnoses of Vets

A

PTSD,
depressive disorders

were number one and two on the list,

acute stress disorder - within days of event, diagnosis is made within the first month of symptoms.

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74
Q

Licit vs Illicit

A

Licit - legal

Illicit - illegal

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75
Q

What do we give for Excited Delirium

A

Benzos

Versed IM -

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76
Q

What do you give for Benzo overdose

A

Flumazanil - 0.2mg IV over 15 secs

signs: respiratory depression

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77
Q

Signs and Treatment for Atropine or Benadryl (and TCA) overdose

A

Anticholinergic overdose
(and Antihistamine, TCA)

Dilated pupils, blurred, tachy,, dry as a bone.

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78
Q

Define poison

A

a substance whose chemical action could damage the body

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79
Q

Define Toxin

A

a poison produced by bacteria, animals, or plants

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80
Q

Define Bioavailability

A

the percentage of unchanged substance that is present in the systemic circulation.

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81
Q

Define Half-Life

A

the amount of time needed for the average person to metabolize or eliminate 50% of a substance in the plasma. The half-life of a drug is commonly expressed in minutes, but it is possible for the half-life to last for hours or even days.

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82
Q

Intentional vs Unintentional Toxicology

A

Intentional: suicide, sexual assault, chemical terrorism

Unintentional: neglect, oversight, exposure, several doses for pain, child ingestion

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83
Q

What are the 4 primary routes of entry

A

Ingestion, inhalation, injection, and absorption

84
Q

Where does most absorption take place?

A

the small intestine

(little absorption occurs in the stomach)

85
Q

When is activated charcoal most effective

A

close to time of ingestion

(of extended release capsules)

will not bind to alcohols

86
Q

Define Chemical suicide

A

also called detergent suicide, is a method that involves mixing certain household chemicals in an enclosed space to create toxic gases (such as hydrogen sulfide and hydrogen cyanide), which are then inhaled.

87
Q

For inhalation in an industrial environment as for clues such as

A

Safety Data Sheet (SDS)

Shipping manifest

Bill of Lading

Transportation Placards

88
Q

What is WISER

A

Its an information database that gives info about hazardous chemicals and treatment info.

89
Q

What must be done in inhalation poisoning

A

Correction of hypoxia is a must; deliver a high concentration of oxygen and make sure to support adequate ventilation, if needed. Establish vascular access, apply an electrocardiogram (ECG) monitor, and perform pulse oximetry and capnography.

90
Q

What is an example of absorption, and speed

A

Slow absorption

pesticides, such as organophosphates

91
Q

Define Toxidrome

A

The syndrome-like symptoms of a class or group of similar poisonous agents are termed a toxic syndrome or Toxidrome

92
Q

What are the 5 major toxidromes

A

narcotic,
sympathomimetic,
sedative-hypnotic,
cholinergic,
anticholinergic

93
Q

Give examples and signs of Narcotic Toxidrome

A

Narcotic (Opioid)

Ex. Morphine, Heroin, Fentanyl, Aspirin Combo, Methadone

Signs: pinpoint, hypotension, stupor, hypoventilation, resp arrest, track marks

94
Q

Give examples and signs of Sympathomimetic Toxidrome

A

Ex. cocaine, caffeine, bath salts, nasal decongest, amphetamine

Signs: hypertension, diaphoresis, Tachy, Dilated pupils (mydriasis), seizures, hyperthermia, paranoia

95
Q

Give examples and signs of Sedative-Hypnotic Toxidrome

A

Ex. Diazepam, Midazolam, Propofol, Ethanol

Signs: Hypoventilation, resp arrest, (ataxia = loss of muscle coord) hypotension, CNS depression, slurred speech, mental confusion, resp depression

96
Q

Give examples and signs of Cholinergic Toxidrome

A

Ex. Organophosphates

Signs: DUMBELS: diarrhea, Urination, Miosis (constrict), Muscle weak, Brady, Emesis, Lacrimation (tearing of eyes) Seizures, respiratory depression, apnea (not breathing)

97
Q

Give examples and signs of Anticholinergic Toxidrome

A

Ex. Atropine, antihistomines, diphenhydramine, TCAs

Signs: hyperthermia, Tachy, Dialted pupils (mydrysis), mild hallucin, delirium, flushed skin, agitation

98
Q

Patient has symptoms:

Hypoventilation, Resp arrest, Bradycardia, Hypotension

but which is for pinpoint pupils and which is for dilated pupils

A

pinpoint - narcotic

dilated - barbiturate

99
Q

Define Idiosyncratic Reaction

A

An allergic reaction that was unexpected

100
Q

Define Wernicke Korsakoff Syndrome

A

is a memory disorder that results from vitamin B1 deficiency and is associated with alcoholism. Damages nerve cells, part of the brain involved with memory.

101
Q

Define Nystagmus

A

Double vision, eyelid drooping

102
Q

Symptoms of Wernicke
vs
Symptoms of Korsakoff

A

W: confusion, coma, death, double vision (nystagmus), leg tremor (ataxia)

K: can’t form new memories, memory loss, confabulation, hallucinations

103
Q

Define Antidote

A

Something to counteract poison

104
Q

Define Caustics

A

Chemicals that are acids or alkalis, causing damage to tissues

105
Q

Define Amphetamines

A

Class of drugs, stimulants, ex. methamphe, MDA, Ecstasy, MDMA,

106
Q

Define DT’s

A

Delirium Tremens, withdrawal from alcoholism, fever sweating, agitation, seizures, can be fatal.

tremors, diaphoresis, confusion, fever, reslessness, and tachy

107
Q

Define Habituation

A

A physical tolerance and psych dependence on drugs

108
Q

Define Lithium

A

A common mood stabilizer used for bipolar

109
Q

Define Hydrocarbons

A

Compdrogen and carbon atoms, from the distillation of petroleum

110
Q

Define Hallucinogen

A

An agent that produces false perceptions in any one of the 5 senses

111
Q

Define Potentiation

A

Enhancement of the effect of one drug by another drug

112
Q

Define MAOI’s

A

Monoamine Oxidase Inhibitors

psych med used for depression

increases norepi and serotonin levels in CNS

113
Q

Define SSRI

A

Selective Serotonin Reuptake Inhibitors

A class of anti-depressants that inhibit the reuptake of serotonin

114
Q

Define Rhabdomyolysis

A

The destruction of muscle tissue leading to the release of potassium and myoglobin

115
Q

Define Salicylates

A

A primary ingredient in aspirin

116
Q

Define Serotonin syndrome

A

an idiosyncratic complication that occurs with anti-depressant therapy, lower muscle rigidity, confusion, agitation

117
Q

Define withdraw syndrome

A

predictable signs and symptoms, after abruptly quitting a drug or quickly decreasing the usual dosage of a drug

118
Q

Define TCA

A

Tricyclic Anti-Depressants

A group of meds for depression and pain, minimal dosing errors can cause toxic results

119
Q

Alcoholism is diagnosed when

A

patient has physical and psychological addication to ethanol

120
Q

Alcohol abuse causes

A

subdural hematoma
gi bleeding
a higher risk of burns

121
Q

Best source for accidental ingestion

A

Poison center

122
Q

The treatment for Cocaine, Amphetamine, Meth

A

Airway
IV
Contact med control for sedation if violent

123
Q

Signs and symptoms of overdose with cardiac drugs

A

Hypotension
Weakness or confusion
nausea and vomiting

124
Q

Signs and symptoms of Cyanide poisoning

A

Altered mental
Rapid labored resp, that become slow
A BITTER ALMOND SCENT

125
Q

TCA overdose signs

A

Tachy hr
Tachypnea (rapid breathing)
Hypotension

126
Q

Salicylate overdose signs

A

a history of drug abuse or psychiatric condition

127
Q

Signs of Foxglove ingestion

A

cardiac dysthythmias

128
Q

CO poisoning treatment

A

highest concentration of oxygen to displace CO molecules from the hemoglobin

129
Q

Acid vs Alkalis with water

A

Acid is more water soluble
(diluted quick)

Alkalis needs water continually flowing (takes longer)

130
Q

Signs of huffing

and treatment

A

Euphoria
anesthesia
weakness
vomitting
ab cramps
loss of coordination
blindness
dysthyhmias
grand mal seizure

decon
ABC
high O2
IV
ECG
Normal Salin for hypotension
Transport

131
Q

Hydrocarbon products cause

A

GI irritation
abdominal pain
diarrhea
belching

can be life-thratening

132
Q

What are some TCA overdose ecg concerns

A

prolonged PR interval
tachy
widening QRS
terminal E wave greater than 3mm
Prolong QT interval

133
Q

Organic Mercury is

A

lipid soluble and accumulates in the liver

134
Q

Two sedative drug Toxidrome example

and signs of sedative overdose

A

Diazepam (valium) and Midazolam

confused
hypo perfusion
slurred speech
SLEEPY

135
Q

Two Stimulant drug Toxidrome examples

and signs of Stimulant overdose

A

Cocaine, diet aids, Methanphetamines and Nasal decongestion

agitated
paranoid

136
Q

Signs- cold dry skin

could be…

A

sedative overdose

or alchol

137
Q

signs - resp slower 12 shallow

could be…

A

Sedative overdose

138
Q

signs - Pupils dilated and not reactive to light, shallow breathing, sluggishness, drowsy, lack of consciousness

could be…

A

Barbituate overdose

139
Q

Define Comatose

A

prolonged unconsciousness, from trauma, intoxication or diabetes, or infection

140
Q

Define Stuporous

A

unresponsiveness, but aroused by vigorous physical stimulation

141
Q

Define Obtunded

A

Dulled or reduced level or alertness

142
Q

Treatment for Comatose patient

A

airway
breathing -vent
circulation
high o2
IV - poss dextrose
antidote
Transport
12 lead, poss intubate

143
Q

contraindication for activated charcoal

A

alchol, acid, or alkali

144
Q

Treatment for ingested drano

A

abc
high o2
IV
consider antidote
manage shock,coma,seizures
transport LEFT lateral

145
Q

Signs of Ethylene Glycol Toxicity

and treatment

A

High bp
High respiration, noisy crackles
High hr

24 hours after drinking

ABC
IV
BGL
Consult for Sodium Bicarb
Transport

146
Q

Signs of Methyl Alcohol Poisoning

and treatment

A

Pupils react sluggishly to light
abdomen rigid
speech slurred, barely walk
elevated vitals

ABC
IV
BGL
Consult for Sodium Bicarb
Transport

147
Q

Signs of CO poisoning

and treatment

A

Vomiting
pale and dehydrated
bounding pulse
seizures
nausea
HEADACHE

remove, open windows
ABC
High O2
IV
Rest
ECG
Transport to hyperbaric

148
Q

Signs of Organo phosphate posioning

and treatment

A

nausea
ab pain
weakness
chest tight
pale and diaphoretic
hr low
respiration up, labored
pupils constricted
salivation, breath smells like garlic

decon
ABC
suction
high o2
IV/IO
ATROPINE
Admin Pralidoxime auto injector
ECG
Transport

149
Q

Who is at risk for Toxic Lithium levels

A

patients who take lithium and NSAIDS (slows renal clearance of lithium)

150
Q

Signs of caustic substances

A

severe resp distress
pain in mouth, throat, or chest

151
Q

Ex of poison with strong acid

A

toilet cleaners, batteries

152
Q

Ex of poison with strong alkali

A

drano, dish detergent

153
Q

Ex of poison with hydro carbons

A

paint thinner, gasoline, spray paint

154
Q

Ex of toxic plants

A

diffenbachia, fox glove, caladium

155
Q

What are the stages of Acetaminophen toxicity

A

1 - 24hrs - nausea vomit
2 - RUQ pain
3 - GI symptoms
4 - Liver failure, death

156
Q

Define Labile

A

Rapidly shifting among different emotional states

157
Q

Define Organic Brain Syndrome

A

temp or perm dysfunction of the brain

158
Q

Typical signs of (only) organic brain syndrome

A

Delirium
Visual hallucinations
Confabulation
Coma

159
Q

Typical signs of (only) psychiatic illness

A

Obessional thinking
Flat affect
Compulsions
Circumstantial thinking

160
Q

Typical signs of both Psychiatric and Organic illness

A

Distractibility
Anxiety

161
Q

Lisinopril

A

class - ace inhibitor
for - HTN, post MI
trade name - zestril

162
Q

Levothyroxine

A

class - hormone
for - hypothyroidism
trade name - synthroid

163
Q

Metformin

A

class - anti-diabetic
for - type 2 diabetes
trade name - glucophage

164
Q

Simvastatin

A

class - statin
for - high cholesterol
trade name - zocor

165
Q

Atorvastatin

A

class - statin
for - high cholesterol
trade name - lipitor

166
Q

Metoprolol

A

class - beta blocker
for - HTN, angina
trade name - lopressor

167
Q

Omeprazole

A

class - proton-pump inhibitor
for - gerd, ulcers, heartburn
trade name - prilosec

168
Q

Amlodipine

A

class - calcium channel blocker
for - HTN, angina
trade name - norvasc

169
Q

Cyanide poisoning kit

A

Hydroxycobalamin
5g IV/IO

170
Q

Explain how methyl alcohol poisonings and ethylene glycol cause such toxicity in the human body.

A

In methyl alcohol, metabolism breaks down into formaldehyde and formic acid.

For ethylene glycol, metabolism breaks down into toxic metabolites such as aldehydes, lactate, oxylate, and glycolate. These substances inhibit cellular respiration, glucose metabolism, and also cause metabolic acidosis.

171
Q

Dose of Activated charcoal

A

both adult and ped dose is
1-2g/kg PO/NG

172
Q

Name four heavy-metal poisonings.

A

Lead, Iron, Mercury, Arsenic

173
Q

What are the four routes of poisonings? Describe a type of toxin for each route.

A

1) Ingestion. An example of a toxin via this route is prescription medication overdose.

2) Inhalation. An example of a toxin via this route is cyanide poisoning via smoke inhalation.

3) Injection. An example of a toxin via this route is a jellyfish sting.

4) Absorption. An example of a toxin via this route is organophosphate poisoning.

174
Q

List three common substances, signs or symptoms of overdose, and general treatment guidelines for the drug class hallucinogens.

A

Three common substances in the hallucinogen class include LSD, Ketamine, and Phencyclidine (PCP). Signs and symptoms of an overdose include:1) violent outbursts

2) rapid change in mood

3) hypotension

4) bradycardia

5) bradyapnea

6) seizures, coma, death

General treatment guidelines for patients who have used hallucinogens include:

1) prioritizing scene and provider safety

2) ABCs

3) benzos

4) fluids

5) anti nausea medications

175
Q

List three common substances, four signs or symptoms of overdose, and general treatment guidelines for the drug class narcotics, opiates, and opioids.

A

Three common opioids include: fentanyl, Percocet, and Oxycodone. Four signs or symptoms of overdose include:

1) Coma

2) seizures

3) cardiac arrest

4) respiratory arrest

General treatment guidelines include:

1) protect the airway

2) oxygenate the patient

3) ECG

4) IV access

5) Naloxone and naltrexone

176
Q

What is the difference between drug abuse and drug addiction?

A

Drug abuse is any use of a drug that causes physical, psychological, economic, legal, or social harm to the user or others affected by the user’s behavior.

Drug addiction, on the other hand, is a chronic disorder characterized by the compulsive use of a substance that results in the physical, psychological, economic, legal, or social harm to the user…and the user continues to use the substance despite the harm.

177
Q

Older patient with Altered mental and smell

A

UTI

178
Q

MD protocol for CO poison

A

Remove environment - PPE
IV

179
Q

For beta blocker overdose

A

Give glucacon 1mg IVP every 5mins

180
Q

For Sodium channel blocker
and TCA overdose

A

Give Sodium BiCarbbonate

1 mEq/kg IVP bolus initially

181
Q

Opiate vs Opioid

A

Opiate - used to describe various alkaloids from opium or poppy (ex. morphine, codeine)

Opioid - synthetic narcotic with sedative properties not from opium (ex. oxy, fentanyl, tramadol)

182
Q

Name 3 opioids

A

Oxycodone, Fentanyl, Tramadol

183
Q

Name 3 Opiates

A

Opium, Morphine, Codeine

184
Q

Fentanyl vs Morphine

A

both analgesic narcotics,

fentanyl is more potent (doesnt mean stronger, need less) shorter half life

Morphine has vasodilatory due to histamine release

185
Q

Patho of Opioids

A

Effects CNS
binds with Delta, Kappa, and MU
gives euphoric sensation

186
Q

Define Agnosia

A

Failure to recognize objects

187
Q

Define Cataonia

A

Immobility and stupor

188
Q

Define Dementia

A

Gradual memory loss

189
Q

Define Paranoid

A

Distrust and suspicion

190
Q

Define Antisocial

A

Disregard for rights of others

191
Q

Define Narcissistic

A

Need for admiration

192
Q

Define Avoidant

A

Social inhibition

193
Q

Define Dependent

A

submissive and clinging behavior

194
Q

Define Aphasia

A

Impaired ability to speak

195
Q

Define Apraxia

A

Impaired ability to carry out motor function

196
Q

What are the signs of Sympathomimetic Toxins

A

HR/BP - way up
Resp - up
Temp - up
Pupils - Dialated
Skin - diaphoretic (main sign)
Mental - agitated

possible - cocaine, amphetamines, diet drugs

give - act charcol (consult and alert)
Hypertension - benzos (valium)

197
Q

What are the signs of Anticholinergic Toxins

A

HR/BP way up
Resp - up
Temp - way up
Pupils - Dialated
Skin - DRY (main sign)
Mental - agitated

possible - atropen, TCA, antihistamine

give -

198
Q

What are the signs of Cholinergic Toxins

A

HR/BP - way down (main sign)
Resp - Down
Temp - Down
Pupils - Constricted
Skin - Copiously wet (main sign)

possible - SLUDGEM

give -

199
Q

What are signs of Opioids

A

Resp way down
Pupils - constricted
Skin - normal
Mental - somnolent-coma

200
Q

Define Doudote

A

Pralidoxime Chloride and Atropine

201
Q

Treatment for OPIOID

A

Naloxone (Narcan) 0.4-2mg IV/IO/IN
4mg in 1 nare

BVM, ECG, o2

Vitals down pinpoint pupils, skin normal

202
Q

Treatment for SEDATIVE

A

Flumazenil (consider, but may seize)
Consider Charcoal (consult)

Vitals all down resp, bp, hr, pupils normal

203
Q

Treatment for Cholinergic

A

Atropine for Organo (1mg IV, every 3-5mins max dose 3mg)

Midazolam/Versed (10mg/IM for seizures)

ECG, IV, Capno, O2

Vitals Resp up, HR/BP down, Pinpoint pupils

204
Q

Anticholinergic Treatment

A

Midazolam/Versed 01.mg/kg, 2mg increaments slow IV push (max 5mg)

Cooling

vitals pupils not reactive, dry as hell, hr/bp up

205
Q

Treatment for SYMPATHOMIMETIC

A

Midazolam/Versed 01.mg/kg, 2mg increaments slow IV push (max 5mg)

vitals pupils reactive, bp/hr resp up

cooling iv fluids

Paramedic (24 decks)

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