Chap 21 Flashcards
Poison
Any substance that can harm the body by altering cell structure or functions
Can be corrosive or irritant, destroying skin and other body tissues.
Poisonous gas can act as a suffocating agent, displacing oxygen in the air
Systemic poisons causing harm to the entire body or to an entire body system.
These poisons can critically depress or overstimulate the central nervous system, causing vomiting And diarrhoea, prevent red blood cells from carrying oxygen or interfere with normal biochemical processes In the body at the level of the cell.
Factors. Nature of poison, concentration, how it entered the body, age weight and general health
Toxins
A poisonous substance secreted by bacteria, plants and animals
Botulism
Bacterial contaminants in food may produce toxins, some of which can cause deadly diseases
Poisons are classified into 4 types
Ingested poison
Inhaled poison
-volatile liquid chemicals - able to change very easily from a liquid into gas
Absorbed poison
- through unbroken skin
- many are corrosive or irritants that will injure the skin then be slowly absorbed
- Ex. Insecticides and agricultural chemicals
Injected poison
-Ex. Illicit drugs, snake fangs or insect stingers
Patient information assessment
What substance was involved
When did the exposure occur
How much was ingested
Over how long a period did the ingestion occur
What interventions has the patient, family, or well-meaning bystanders taken
What is the patients estimated weight
What effects is the patient experiencing from the ingestion
Common poison signs
Nausea and vomiting are two of the most common results of poison ingestion but you may also find altered mental status, abdominal pain, diarrhea, chemical burns around the mouth and unusual breath odors
Food poisoning
Food that has been improperly handled or cooked. Can be caused by several different bacteria that from when exposed to the right conditions.
Some food poisonings are the result of bacteria causing an infection in the patient (symptoms may occur a day or so after ingestion), other times it may be the result of toxins formed by bacteria that contaminate the food, and it is these toxins that result in symptoms (usually within hours of ingestion)
Signs and symptoms include nausea, vomiting, abdominal cramps, diarrhoea and fever
Activated charcoal
Works through adsorption, the process of one substance becoming attached to the surface of another
Activated charcoal is not an antidote; however through the adsorption or binding process in many cases it will prevent or reduce the amount of poison available for the body to absorb.
Many poisons but not all are adsorbed by activated charcoal
Medical direction will determine whether the use of activated charcoal is appropriate
Activated charcoal contraindications
Patient who cannot swallow obviously cannot swallow activated charcoal
Patients with altered mental status might choke on activated charcoal and aspirate it into lungs
Patients who have ingested acids or alkalis should not take activated charcoal because the caustic material may have severely damaged the mouth, throat and esophagus. Damage is already done
Patient who have accidentally swallow while siphoning gasoline should not be given activated charcoal. The patient will be coughing violently and possibly aspirating the gasoline
Activated charcoal isn’t indicated in cases of food poisoning
If patient refuses charcoal, notify medical direction and continue reassessment and care
Activated charcoal vs syrup of ipecac
A traditional treatment for poisoning used to be syrup of ipecac. This orally administered drug causes vomiting in most people with just one dose. When vomiting occurs, it results, on the average, in removal of less than one-third of the stomach contents. because ipecac is slow, is relatively ineffective, and has the potential to make a patient aspirate vomitus, it is rarely used today.
Activated charcoal is the first choice for health care providers in most poisoning and overdose cases
Dilution
Thinning down or weakening by mixing with something else. Ingested poisons are sometimes diluted by drinking milk or water. Dilution with water may slow absorption slightly, whereas milk may soothe stomach upset. Frequently advised for patients who, as determined by medical direction or poison control, do not need transport to a hospital
- An adult should drink 1-2 glasses of milk or water
- Child should typically be given 1/2 to one full glass.
Activated charcoal drug
Generic: activated charcoal
Trade: SuperChar, InstaChar, Actidose, Liqui-Char
Indications
-Poisoning by mouth
Contraindications
- Altered mental status
- Ingestion of acids or alkalis
- Inability to swallow
Medication form
- Premixed in water, frequently available in a plastic bottle containing 12.5 grams of activated charcoal
- Powered-should be avoided in the field
Dosage
- Adults and children: 1g activated charcoal/kg of body weight
- Adult 25-50g
- Pediatric 12.5-25g
Side effects
- Some patients have black stools
- Some patients may vomit, particularly those who have ingested poisons that cause nausea. If the patient vomits, repeat the dose once
Antidotes
A substance that will neutralize the poison or its effects. There are only a few genuine antidotes and they can be used only with very small number of poisons. Modern treatment of poisonings and overdoses consist primarily of prevention of absorption when possible (activated charcoal) and good supportive treatment (such as airway maintenance, administration of oxygen, treatment for shock). In a small number of poisonings, advanced treatment are administered in a hospital (antidotes and kidney dialysis.
Naloxone is a popular antidote
Naloxone
Generic: Naloxone
Trade: NARCAN
Indications
- Suspected narcotic overdose
- Coma of unknown cause
Contraindications
-Patient breathing adequately and able to maintain own airway
Form
-Liquid
Dosage
-0.4-2mg
Side effects
- May precipitate withdrawals in patients dependent on narcotics
Naloxone administration
- Obtain medical direction, either online or offline
- Inspect the patients nostrils to be sure there are no obstructions to intranasal administration
- Consider restraining the patient before drug administration if you believe the patient may become combative
- Attach the atomizer to syringe
- Push the atomizer gently but firmly into the nostril opening
- Push the plunger of the syringe firmly but briefly until the desired amount of liquid has been expelled from the syringe. Limit the amount of fluid administered at one time to 0.5ml per nostril
- Repeat as needed with the other nostril
- Record 5 R’s
Common inhaled poisons
Carbon monoxide, chlorine gas, ammonia, sprayed agricultural chemicals and pesticides and carbon dioxide (from industrial sources)
Acetaminophen poisoning
Most common cause of hospitalization of overdose. If someone takes too much of the drug, the liver becomes overwhelmed and unable to detoxify the substance. Over the next several hours, the liver sustains irreparable damage if nothing is done. if the antidote is given within the first 12 hours after an overdose, the patient should recover with a functioning liver.
-During the first 4-12 hours, the most the patient may experience is loss of appetite, nausea, and vomiting. It isn’t until a day or two later that the patient typically experiences right upper quadrant pain and jaundice, when its too late for the antidote to work
Patient assessment for inhaled poisons
What the substance was involved?
When did the exposure occur?
Over how long a period did the exposure occur?
What interventions has anyone taken?
What effects is the patient experiencing from the exposure?
Carbon monoxide
- Most common inhaled poison
- Odorless, colorless and tasteless gas
- Usually from motor-vehicle exhaust and fire suppression
- Recent increase due to improperly vented wood-burning stoves and the use of charcoal for heating and indoor cooking without proper ventilation
- Other causes- Malfunctioning oil, gas and coal burning furnaces and stoves.
- You should suspect carbon monoxide poisoning whenever you are treating a patient with vague, flulike symptoms who has been in an enclosed area.
- Administer 100% oxygen and to transport these patients to a hospital. Oxygen is an antidote for carbon monoxide poisoning but it takes time to “wash out” the carbon monoxide from the patients bloodstream
Administer oxygen even though a SpO2 monitor reads 100% due to the monitor reading the Carboxyhemoglobin in the blood
Signs and symptoms of carbon monoxide
- Headache especially “a band around the head”
- Dizziness
- Breathing difficulty
- Nausea
- Cyanosis
- Altered mental status; in severe cases, unconsciousness may result
Smoke inhalation
Smoke inhalation is often associated with thermal burns as well as with effects of chemical poisons within the smoke
Substances found in smoke burn the skin, irritate the eyes, injure the airway, cause respiratory arrest and in some cases cause cardiac arrest
Signs
- Difficulty breathing
- Coughing
- Breath that has a “smoky” smell or the odor of chemicals involved at the scene
- Black (carbon) residue in the patients mouth and nose
- Black residue in any sputum coughed up by the patient
- Nose hairs singed from superheated air
Detergent suicides
Popular in japan. Mixing two easily obtained chemicals to cause a release of toxic hydrogen sulfide gas.
- In japan its frequently toilet cleaner and bath salts. the same kind of bath salts aren’t available in the US but other chemicals are available
- Typically a source of acid, such as a strong household cleaner and a source of sulfur, often a pesticide will quickly release significant amounts of toxic hydrogen sulfide gas.
Hydrogen sulfide
Chemical released in detergent suicides
- Best known for its rotten egg odor, but less well known is that, even at moderate concentrations, it can be quite dangerous. Hydrogen sulfide not only takes the place of oxygen but also bonds with iron in cells, preventing oxygen from binding to those cells and getting to where its needed.
- Mild exposure an result in coughing, eye irritation, and sore throat. More severe exposures can lead to dizziness, nausea, shortness of breath, headache, and vomiting. In severe cases fluid will collect in the lungs
Absorbed poisons
Frequently irritate or damage the skin. However some poisons can be absorbed with little or no damage to the skin
- Remove contaminated clothing
- Powders- Brush powder off the patient; then continue as for other absorbed poisons
- Liquids-Irrigate with clean water for at least 20 minutes
- Eyes-Irrigate for at least 20 mins
-“Neutralizing” acids or alkalis with solutions such as dilute vinegar or baking soda in water should not be done
Alcohol abuse
EMTs often don’t take alcohol patients seriously due to belligerent or unusual behavior. Chronic drinkers often have derangements in blood sugar levels, poor nutrition, the potential for considerable gastrointestinal bleeding and other problems.
Alcohol withdrawal
referring to alcohol or drug withdrawals in which the patients body reacts severely when deprived of the abused substance
Alcohol-withdrawals patient may experience seizure or delirium tremens (DTs), a condition characterized by sweating, trembling, anxiety and hallucinations.
Alcohol withdrawals include
- Confusion and restlessness
- Unusual behavior, to the point of demonstrating “insane” behavior
- Hallucinations
- Gross tremors of the hands
- Seizures
- Hypertension
- Tachycardia
Refusal of treatment of a patient under the influence
A patient under the influence of alcohol cannot make an informed refusal of treatment or transport. Run as a implied consent
Substance abuse
Indicates a chemical substance is being taken for other than therapeutic (medical) reasons.
Uppers
- Stimulants that affect the nervous system and excite the user.
- Attempt to relieve fatigue or to creat feelings of well-being.
- Ex. caffeine, amphetamines, and cocaine. Also included is bath salts. These are synthetic drugs that have very potent stimulant effects and sometimes hallucinogenic effects
Downers
Depressant effect on the central nervous system,
- Used as a relaxing agent, sleeping pill or tranquilizer
- One example is Rohypnol (flunitrazepam) or “Roofies”. “Date rape”
- Another is GHB (gamma hydroxybutyrate)- also known as Georgia Home Boy or goop. As well as depressing the central nervous system, it produces a sense of euphoria and sometimes hallucinations. It has caused respiratory depression so severe that patients have required assisted ventilations even though some of them were still breathing
Narcotics
Relieves pain
- Produces stupor or sleep
- Produces an intense state of relaxation or feeling of well being
Types
- Codeine
- OxyContin (oxycodone)
- Heroin
Three signs (Opiate triad)
- Coma
- Pinpoint pupils
- respiratory depression
Hallucinogens
- LSD, PCP and certain types of mushrooms are mind-affecting drugs that act on the nervous system to produce an intense state of excitement or a distortion of the users perception
- This class of drugs has few legal uses.
- A newer hallucinogen is ecstasy (XTC, X,MDMA)
Volatile chemicals
Produces vapors that can be inhaled. they can give an initial rush then act as a depressant on the central nervous system.
-Cleaning fluid, glue, model cement and correction fluids used to correct ink based errors are common abused volatile chemicals
Designer drugs
substances that chemically resemble traditional drugs but have a slight difference in the molecular formula or composition.
-Produce similar effects but based on their slight chemical differences, do not fall under the traditional legal definition of prohibited drugs
Upper signs
Display excitement, increased pulse and breathing rates, rapid speech, dry mouth, dilated pupils, sweating and the complaint of having gone without sleep for long periods. Repeated high doses can produce a “Speed run”. The patient will be restless, hyperactive, and usually very apprehensive and uncooperative
Downers signs
Sluggish, sleepy patients lacking typical coordination of body speech. Pulse and breathing rates are low, often to the point of a true emergency
Narcotics Signs
Reduced rate of pulse and rate and depth of breathing, which is often seen with lowering of skin temp. Pupils constricted, often pinpoint in size. Muscles are relaxed and sweating is profuse. In over doses, coma is common
Hallucinogens
Fast pulse rate, dilated pupils, and a flushed face. “sees” or “hears” things, has little concept of real time and may not be aware of the true environment
Volatile chemicals
dazed or show temporary loss of contact with reality. May develop a coma. Linings of the nose and mouth may show swollen membranes. May complain of a funny numb feeling or tingling inside the head. Changes in heart rhythm can occur
