Chapter 21 Flashcards by Gail I

toxicology is study of toxic/poisonous substances
…: any substance whose chemical action can damage body structures/impair body function
..: a poisonous substance produced by bacteria, animals, or plants
… is the misuse of any substance to produce a desired effect
…: a toxic dose of a drug

poison
toxin
substance abuse
overdose

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try to determine the .. of the poison–> look around immediate area for clues; take any suspicious materials; med containers at scene can provide critical info; examine vomit for ..

nature; pill fragments

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four routes for poisons to enter body: 
… 
… 
… 
…

inhalation
absorption
ingestion
injection

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inhaled poisons:
move patient into .. immediately
patient may require ..
if you suspect presence of toxic gas, call HazMat
all patients who’ve inhaled poison require immediate transport

fresh air; supplemental ox

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inhaled poisons cont:
some patients use these to … in a vehicle–> exhaust fumes contain high levels of …
… or … in a tightly sealed vehicle create a type of gas chamber; when you open the door, you may be overcome as well–> contact haz mat responders and have them remove victim

commit suicide; CO; chemicals; detergent

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(absorbed and surface contact poisons) can affect patient in many ways:
…, … or … damage
… burns
…
… effects
distinguish btwn contact burns and contact absorption

skin; mucous membrane; eye;
chemical
rashes
systemic

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(absorbed and surface contact poisons) signs and symptoms: 
a history of ...
… or … on a patient's skin
.. 
.. 
.. 
… of skin
… of the substance

exposure
liquid; powder
burns
itching
irritation 
redness
odors

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(absorbed and surface contact poisons) emergency treatment: avoid contaminating yourself/others
remove the substance and remove all …
flush and wash skin: if dry powder has spilled, brush off and flood with water for … mins then wash with … and …
if liquid has spilled, flood for … mins

contaminated clothes; 15-20; soap; water; 15-20

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(absorbed and surface contact poisons) if a chemical agent has been introduced to eyes, .. them quickly and thoroughly

irrigate

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(absorbed and surface contact poisons) in industrial setting:
… and specific protocols may be available
hazmat to assist
obtain .. data sheets

safety showers; material safety

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(ingested poisons) about 80% of poisonings by moith
tends to be … in children and … in adults
signs and symptoms vary with:
.. of poison
… of patient
… that has passed since ingestion

accidental; deliberate; type; age; time

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(ingested poisons) signs and symptoms may include … around mouth, … pain, …, cardiac, … or …
treat signs and symptoms and notify the poison center and med control
consider if there is unabsorbed poison in GI tract and whether you can safely …

burns; GI; vomiting; dysrhythmias; seizures; prevent absorption

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(ingested poisons) some EMS systems allow EMTs to administer

activated charcoal

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(injected poisons) exposure by injection includes … drug abuse and … by insects, arachnids, and reptiles
usually absorbed quickly into the body–> cannot be .. or removed from the body in the field

intravenous; envenomation; diluted

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signs and symptoms for injeccted poisons: 
…
…
…
…
…
...

weakness
dizziness
fever
chills
unresponsiveness
excitability

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(injected poisons) remove rings, watches, and bracelets from areas round injection site if … occurs
monitor airway, provide …, be alert for nausea/vomiting, and transport promptly

swelling occurs; high flow ox

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history taking--ask these qs: 
… is the substance involved?
… wsa the patient exposed?
what was the … of exposure?
has the patient/bystander performed any ..? 
how much does the patient ..?

what; when; level; intervention; weigh

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secondary assess–> physical exams:
focus on the area of the body involved with the .. or the … of exposure
look for alterations in LOC, pulse, respirations, BP, and skin

poisoning; route

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dilute airborne exposures with …
remove contact exposures with copious amounts of .. unless contraindicated
consider … for ingested poisons

oxygen; water; activated charcoal

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if the poisoning/exposure occurred in work setting, bring, or have the company fax, the … to the hospital

material data sheet

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emergency med care:
remove … or … from the patient’s mouth
wash/brush poison from patient’s skin

tablets; fragments

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Emergency med care:
activated charcoal binds to … which are then carried out of the body
not indicated for patients who have:
ingested … poisons, .., …, …, …, …, … acids, or … solvents
who have a decreased LOC and can’t protect their airway

specific toxins; alkali; cyanide; ethanol; iron; lithium; methanol; mineral; organic

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activated charcoal:
you will carry as a premixed …, with the bottle containing up to … g of activated charcoal
usual dose is .. of body weight
obtain med control approval, shake bottle vigorously, and record time it was administered

suspension; 50; 1 g per kg

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side effects of charcoal are … and … stools; if the patient has ingested a poison that causes nausea, he or she may … after taking charcoal and the dose will have to be repeated

constipation; black; vomit

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over time, a person may need increasing amounts of a substance to achieve the same result --> developing a … known drug abusers have a fairly high incidence of serious and undiagnosed infections, including … and …

tolerance; HIV; hepatitis

alcohol can damage the …, whether thorough chronic overuse or occasional heavy use … use can be more damaging than … use, depending on frequency and context

liver; binge; chronic

alcohol is a powerful …

CNS depressant

alcohol: decreases ...a nd … induces … dulls the sense of .., slows .., and reduces … may cause … and ...behavior and lack of … increases the effects of other drugs

activity; excitement sleep awareness; reflexes; rxn time aggressive; inappropriate; coordination

a person who appears intoxicated may have other med problems: look for signs of .. trauma, .., … rxns, or uncontrolled .. severe acute alcohol ingestion may cause ..

head; mental illness; toxic; diabetes; hypoglycemia

if a patient exhibits signs of serious CNS depression, you must provide .. support--> may cause emesis patients may experiencing frightening hallucinations, or …

respiratory; delirium tremens (DTs)

``` DTs are characterized by: … and … … … … …/… …/… ... ```

``` agitation; restlessness fever sweating tremors confusion; disorientation delusions; hallucinations seizures ```

an … is a type of narcotic med used to relieve pain an … is a subset of this family, and refers to natural, nonsynthetic forms a … is a drug that produces sleep or altered mental consciousness

opioid; opiate; narcotic

… can occur after taking a med prescription | opioids are … and can cause severe respiratory depression

opioid dependency; CNS depressants

``` opioids: … develops quickly often cause … and … may lead to … patients typically appear … and … with .. pupils ```

tolerance nausea; vomiting hypotension unconscious; cyanotic; pinpoint

… reverses the effects of opiate or opioid overdose --> can be given IV, IM, or IN usually by IN

naloxone

barbiturates and benzodiazepines are easy to obtain and relatively cheap--> these drugs are... and can alter ..; patient may appear drowsy, peaceful, or intoxicated

CNS depressants; level of consciousness;

sedative-hypnotic drugs these agents are generally taken by …--> occasionally, capusles are suspended/dissolved in water and injected IV sedative-hypnotics quickly induce … these drugs maybe given to people as a "knock-out" drink your treatment is to ensure airway is patent, assist ventilations, and provide prompt transport

mouth; tolerance

(abused inhalants) these agents are inhaled: …, …, .., … found in .., … compounds, paint .. and … … and … are also abused commonly abused by teenagers

acetone; toluene; xylene; hexane; glues; cleaning; thinners; lacquers gasoline; halogenated hydrocarbons

(abused inhalants) halogenated hydrocarbon solvents can make the heart … to the patient's own adrenaline--> even the action of walking may cause a fatal … use a stretcher to move patient, give … and transport try to keep such patients from struggling with you/exerting themselves

hypersensitive; ventricular dysrhythmia; oxygen

(hydrogen sulfide) highly toxic, colorless, flammable gas with distinctive rotten-egg odor affects all organs, but has most impact on … and … used to …--> referred to as chemical/detergent sucidie

lungs; CNS; commit suicide

``` (hydrogen sulfide) signs and symptoms: … and … … … a loss of … … … … … arrest ```

``` nausea; vomiting confusion dyspnea consciousness seizures shock coma cardiopulmonary ```

(hydrogen sulfide) once patient has been decontaminated, management is largely …--> monitor and assist … and … functions and provide rapid transport

supportive; respiratory; cardiovascular

….: CNS stimulants that mimic the effects of the sympathetic nervous system

sympathomimetics

(sympathomimetics) a … is an agent that produces an excited state--> frequently causes hypertension, tachycardia, and dilated pupils

stimulant

(sympathomimetics) cocaine may be taken a number of different ways: can be .. through all mucous membranes and across skin immediate effects include … and … and last less than an hr

absorbed; excitement; euphoria

(sympathomimetics) acute overdose is genuine emergency: patients have high risk of ..,. cardiac ..,a nd … patients may experience … or don't leave patient unattended provide prompt transport and give supplemental xo

seizures; dysrhythmias; stroke; hallucinations; paranoia

(synthetic cathinones-bath salts) similar to …--> sold as bath salts to escape legal restrictions produce .., increased … and … --> most users snort or nasally insufflate effectrs reportedly last as long as … hrs

MDMA; euphoria; mental clarity; sexual arousal; 48

``` (synthetic cathinones-bath salts) adverse effects: … … loss muscle … lip … … GI conditions … .. elevated … … keep patient calm and transport and consider ALS assistance, as some of these patients may require chemical restraint ```

``` teeth grinding appetite twitching smacking paranoia headache heart rate hallucinations ```

… is chemical in marijuana plant | produces …, …, and … and impairs … and the capacity to do...

THC; euphoria; relaxation; drowsiness; short-term memory; complex thinking

marijuana use could progress to … and … and high doses may cause …,. … or …

depression; confusion; hallucinations; anxiety; paranoia

marijuana may be used as a .. to get other drugs into body inestion can lead to …,c haracterized by chronic weed use and extreme nausea and vomiting relieved only by hot shower/bath

vehicle; cannabinoid hyperemesis syndrome

synthetic marij or spice: refers to a variety of … or .. that resemble THC and produce similar high powerful and unpredictable effects may result, ranging from simple euphoria to complete ...

herbal incense; smoking blends; loss of consciousness

… alter a person's sensory perceptions: classic example is LSD

hallucinogens

(hallucinogens) cause … intensify .. and … generally separate the user from .. patients experiencing a "bad trip" have: …, …, …, and...

visual hallucinations; vision; hearing; reality; hypertension; tachycardia; anxiety; paranoia

(anticholinergic agents) meds that block the … "hot as hare, blind as bat, dry as bone, red as beet, mad as hatter" include atropine, Benadryl, jimsonweed, and amitriptyline the patient can go from normal to … and … within .. mins with exception of …, these usually arent' abused drugs some tricyclic antidepressants have significant anticholinergic effects

parasympathetic nerves; seizure; death; 30; jimsonweed

(cholinergic agents) These agents overstimulate normal body functions that are controlled by the parasympathetic nerves. Include “...” designed for chemical warfare and organophosphate insecticides

nerve gases

``` (cholinergic agents) mnemonic DUMBELs for signs and symptoms: D: U: M: B: E: L: S: ```

``` Diarrhea Urination Miosis Bradycardia, bronchospasm, bronchorrhea (discharge of mucus from the lungs) Emesis Lacrimation (tearing) Seizures, salivation, sweating ```

``` (cholinergic agents) mnemonic SLUDGEM for signs and symptoms: S: L: U: D: G: E: M: ```

``` Salivation, sweating Lacrimation Urination Defecation, drooling, diarrhea Gastric upset and cramps Emesis Muscle twitching/miosis ```

(cholinergic agents) after decontamination: decrease secretions in … and … and provide airway support

mouth; trachea

(cholinergic agents) Antidote kit may be available DuoDote Auto-Injector The kit consists of a single auto-injector containing atropine and pralidoxime. If a known exposure to nerve agents with manifestation of signs and symptoms has occurred, use the antidote kit ...

.on yourself

overdose with … has become common

cardiac meds

… poisoning remans potentially lethal condition | ingesting too much may result in nausea, vomiting, hyperventilation, and ringing in ears (..)

aspirin; tinnitus

``` patients with aspirin poisoning problem frequently have: .. … .. … danger of having .. ```

``` .anxiety confusion tachypnea hyperthermia seizures ```

overdosing with … is also very common: mst be treated promptly and aggressively some alcohols, including … and … are even more toxic than drinking alcohol

acetaminophen; methyl alcohol; ethylene glycol

the non drinking toxic alcohols will cause severe …, …, … and eventually ..

tachypnea; blindness; renal failure; death

food poisoning almost always caused by eating food contaminated with ..: organism itself may cause disease or it may produce .. that cause disease

bacteria; toxins

Salmonella bacterium causes ...Characterized by severe GI symptoms within 72 hours of ingestion, including nausea, vomiting, abdominal pain, and diarrhea Proper cooking kills bacteria, and proper cleanliness in the kitchen prevents the contamination of uncooked foods.

salmonellosis

More common cause of food poisoning is the ingestion of powerful toxins produced by bacteria, often in .... The bacterium Staphylococcus is quick to grow and produce toxins in food. Foods left ... are a common vehicle. Results in sudden GI symptoms, including nausea, vomiting, and diarrhea within 2 to 3 hours after ingestion or as long as 8 to 12 hours after ingestion.

leftovers; unrefrigerated;

(food poison) The most severe form of toxin ingestion is ... Can result from eating improperly canned food Symptoms are neurologic: ... of vision … Difficulty in ...and .. often fatal, symptoms may develop within 1-4 days after ingestion

botulism; Blurring weakness; speaking; breathing

Plant Poisoning A. There are tens of thousands of cases of plant poisoning annually. 1. Many household plants are poisonous if ingested. 2. Some cause... . 3. Some can affect the .. system, the … tract, or the .... B. It is impossible to memorize every plant and poison, let alone their effects. 1. Assess the patient’s airway and vital signs. 2. Notify the regional poison center for assistance in identifying the plant. 3. Take the plant to the emergency department.

local skin irritation; circulatory; GI; CNS