Chapter 21 - Toxicology Flashcards
Almost any substance may be a __________ in certain circumstances.
poison
Different doses can turn even a remedy into a ___________ for example aspirin.
poison
Acute poisoning affects ____ million people each year.
2
____________ poisoning is more common than acute poisoning.
Chronic
Death by poisoning are fairly ________.
rare
Rates of death as the result of poisoning in children have decreased steadily since the 1960s due to ____________-___________ caps.
Child-resistant
Deaths caused by chronic poisoning to adults have been rising as a result of ______ _____.
drug abuse
__________ is the study of toxic or poisonous substances.
Toxicology
A _____ is any substance whose chemical action can damage body structures or impair body function.
poison
A ______ is a poisonous substance produced by bacteria, animals, or plants that acts by changing the normal metabolism of cells or destroying them.
toxin
_________ abuse is the misuse of any substance to produce a desired effect.
Substance
A common complication of substance abuse is __________, when a patient takes a toxic dose of a substance.
overdose
Your primary responsibility to the patient who has been poisoned is to __________ that a poisoning has occurred.
recognize
For your own safety, you must pay attention to your ___________ or you could be exposed to the same substance.
surroundings
The _______, __________, and ________ of the toxic exposer is important.
where
what
how
Very small amounts of some poisons can cause considerable ________ or _________.
damage
death
If you suspect that ingestion or exposure to a toxic substance has occurred, notify ______ _____ and begin emergency treatment at once.
medical control
The signs and symptoms of poisoning vary according to the _______ _______.
specific agent
For your own safety, you must pay attention to your surroundings or you could also become _______ to the same substance.
exposed
The _____, _____, and _______ of the exposure is important.
where
what
how
Very _______ amounts of some poisons can cause considerable damage or
small
If you suspect that ingestion or exposure to a toxic substance has occurred, notify _______ _______ and begin emergency tratment at once.
medical treatment
The signs and symptoms of poisoning vary according to the _____ _____.
specific agent
The presence of injuries at the patient’s mouth strongly suggests the _______ of a poison,
ingestion (swallowing)
If possible, while obtaining the SAMPLE history, ask the patient:
- What substance did you take?
- When did you take it (or become exposed to it)?
- How much did you ingest?
- Did you have anything to eat or drink before or after you took it?
- Has anyone given you an antidote or any substance orally since you ingested it?
- How much do you weigh?
Try to determine the ___________ of the poison.
Nature
Look around the immediate _______ for an overturned bottle, a needle or syringe, scattered pills, chemicals, remains of food or drink items, or even an overturned or damaged plant.
Area
Place any suspicious ___________ in a plastic bag and take it with you.
material
Containers at the scene can provide critical information, such as
name and concentration of the drug ingredients number of pills originally in the bottle name of the manufacturer prescribed dose
If a patient vomits, examine the contents for ______ fragments.
pill
Wear proper _____ _____ ______.
personal protective equipment
Emergency care for a patient who has been poisoned may include actions that range from ________ an anxious parent to performing ___.
reassuring
CPR
Most often, you will not be administering a specific _____ because most poisons do not have one.
antidote
The medication antidote most commonly available to prehospital providers is _________, which is used to reverse the effects of an opioid overdose.
naloxone (Narcan)
Definitive treatment can only be provided at the _____, so transport promptly.
ED
The most important treatment you can perform for a poisoning is _____ and/or physically removing the poisonous agent.
diluting
removing
How you provide treatment depends on ____ the poison got into the patient’s body in the first place.
how
The four routes of poisoning to consider are:
inhalation
absorption (surface contact)
ingestion
injection
All four routes of poisoning can lead to serious and possibly life-threatening conditions. Take care to treat ________ appropriately and to keep ______ safe from harm.
patients
yourself
If you are uncertain how to treat a patient who has been poisoned or exposed to a specific substance, find the container, if possible, and contact _______ ______ and/or the _____ _____ _____ before you proceed.
medical control
poison control center
For ______ poisons, move the patient into fresh air immediately.
inhaled
For _______ poisons, the patient may require supplemental oxygen.
inhaled
If you suspect the presence of a toxic gas, call for specialized resources such as the _______ team.
HazMat
A ____-____ breathing apparatus is necessary to protect yourself from poisonous fumes.
self-contained
Some patients may need ____________ by the HazMat team after removal from the toxic environment.
decontamination
The patient may have the following signs and symptoms:
burning eyes sore throat cough chest pain hoarseness wheezing respiratory distress dizziness confusion headache stridor
All patients who have inhaled poison require ___________ transport to an emergency department.
immediate
Be prepared to use supplemental oxygen via a _______ mask and/or ventilator support with a ______, if necessary.
nonrebreathing
BVM
Pulse oximetry readings may not be accurate with ________ poisons.
inhaled
Make sure a suctioning unit is available in case the patient _________.
vomits
Some patients use inhaled poisons to commit _________ in a vehicle.
suicide
Leaving a car engine running in an enclosed garage can cause exhaust fumes, which contain high levels of ________ ________, to cause the patient to lose consciousness and eventually stop breathing.
carbon monoxide
A recent variation involves using chemicals or detergent in a tightly sealed vehicle as a type of _____ ________.
gas chamber
When you open the door of a vehicle, you may be overcome by the ________ in side of it.
poison
Contact ________ responders and have them remove the victim in a poisoned vehicle situation.
HazMat
Two type of contact poisons are:
absorbed
surface
Absorbed and surface poisons can affect the patient in many ways such as:
skin, mucous membrane, or eye damage
chemical burns
rashes or lesions
systemic effects
It is important to distinguish between contact ______ and contact ______.
burns
absorption
Signs and symptoms of absorbed poisoning include:
a history of exposure liquid or powder on the patient's skin burns itching irritation redness of the skin typical odors of the substance
Emergency treatment for a typical contact poisoning includes:
avoid contamination yourself or others
while protecting yourself, remove the substance from the patient as rapidly as possible
For all absorbed and surface contact poisons, remove all contaminated ________.
clothing
For absorbed and surface contact poisons, flush and wash the ______.
skin
For absorbed and surface contact poisons, if dry powder has been spilled, brush off the powder, then flood the area with water for 15 to 20 minutes, then wash skin with ______ and _______.
soap
water
For absorbed and surface contact poisons, if liquid has been spilled onto the skin, flood with water for _______ to _______ minutes.
15
20
For absorbed and surface contact poisons, if a chemical agent is introduced to the eyes, _______ them quickly and thoroughly.
irrigate
Many chemical burns occur in an __________ setting.
industrial
Safety showers and specific protocols for handling _________ burns may be available in an industrial setting.
surface
A __________ team should be available to assist you in an industrial setting.
HazMat
In an industrial setting, ensure you, your team members, and the exposed patient are thoroughly ___________.
decontaminated
After decontamination, promptly transport to the ______ for definitive care.
ED
In an industrial setting, obtain ______ ______ _______ ______ and transport with the patient; if not immediately available, have the company fax them to the hospital.
material safety data sheets
With ingested poisons, about ________% of poisoning is by mouth.
80
Types of ingested poisons include:
liquids household cleaners contaminated food plants drugs
Ingested poisoning is usually ________ in children and ______ in adults.
accidental
deliberate
Signs and symptoms of ingested poisons vary greatly with the:
type of poison
age of the patient
time that has passed since the ingestion
Signs and symptoms of ingested poisons include:
burning around the mouth, gastrointestinal pain, vomiting, cardiac dysrhythmias, and seizures
With ingested poisons, if the patient has altered mental status, protect the patient from ___________ on vomit.
aspiration
With ingested poisons, consider whether there is unabsorbed poison remaining in the gastrointestinal tract and whether you can safely and effectively prevent its ___________.
absorption
Some EMS systems allow EMT’s to administer active __________.
charcoal
You should always immediately access the airway, breathing, and circulation (ABCs) of every patient who has been _________.
poisoned
Exposure by ___________ includes intravenous drug abuse and envenomation by insects, arachnids, and reptiles.
injection
Injected poisons are usually absorbed quickly into the body or cause intense _____ tissue destruction.
local
Injected poisons cannot be ________ or _______ from the body in the field.
diluted
removed
With injected poisons, the patient’s condition can be life threatening; you must act _________.
quickly
Signs and symptoms of injected poisons include:
weakness dizziness fever chills unresponsiveness excitability
With injected poisons, monitor the airway, provide ___-_____ oxygen, and be alert for nausea and vomiting.
high-flow
Activated charcoal binds to specific toxins and prevents their absorption by the body; the toxins are then carried out of the body in the ______.
stool
Activated charcoal is not indicated for patients who have ingested:
alkali poisons, cyanide ethanol iron lithium methanol mineral acids organic solvents or those who have a decreased level of consciousness and cannot protect their airway
If local protocol permits, you will likely carry plastic bottles of premixed suspension, each containing up to ____ g of activated charcoal.
50
Some common trade names for activated charcoal include:
InstaChar
Actidose
LiquiChar
The usual dose for an adult or child is ____ g of activated charcoal per kilogram of body weight.
1
Activated charcoal for adults is ___ to ____g.
30
100
Activated charcoal for children is ____ to ___ g.
15
30
Before you give a patient charcoal, obtain approval from ________ _______.
medical control
Side effects of ingesting activated charcoal are _____ and ______ _______.
constipation
black stools
If the patient has ingested a poison that causes nausea, he or she may vomit after taking activated charcoal and the dose will have to be ________.
repeated
When giving activated charcoal, be sure to shake the bottle vigorously to mix the __________.
suspension.
Over time, a person who routinely misuses a substance may need increasing amounts of it to achieve the same result. This is called devolving a ___________.
tolerance
Dilute airborne exposures with ________.
oxygen
Remove contact exposures with copious amounts of ___________ unless contraindicated.
water
1 in ____ deaths among working-age adults in the United States can be attributed to excessive alcohol use.
10
Alcohol can damage the ________, whether through chronic overuse or occasional heavy use (binge drinking).
liver
_________ drinking can be more damaging than chronic use, depending on the frequency of the _______ and the surrounding circumstances.
Binge
binging
Alcohol is a powerful ______ depressant.
CNS
Alcohol is a _________ (decreases activity and excitement) and a ________ (induces sleep).
sedative
hypnotic
A _______ is a drug that produces sleep or altered mental consciousness.
opioids
An _________ is a type of narcotic medication used to relieve pain.
opioid
Opioids are named for the opium in poppy seeds, from which ______ and _____ are derived.
codeine
morphine
Synthetic opioids include:
meperidine hydromorphone oxycodone hydrocodone methadone
_____________ opioid drugs are among the most commonly abused drugs in the United States.
Prescription
Patients with _________ _________ are the most commonly accepted sign of opiate abuse.
pinpoint pupils
__________ is an antidote that reverses the effects of opiate or opioid overdose.
Naloxone (Narcan)
Naloxone (Narcan) can be given __________, _________ or _________.
intravenously
intramuscularly
intranasally
Naloxone (Narcan) should only be used intranasally when the patient has _____ respirations or is apneic.
agonal
Place an _________ _______ and ventilate the patient using a BVM prior to administering naloxone.
oropharyngeal airway
In some areas, lay people are permitted to administer ____________; find out from bystanders if the patient was given naloxone.
naloxone
___________ and ________ are easy to obtain and relatively cheap.
Barbiturates
benzodiazepines
Barbiturates and benzodiazepines are ______ depressants and alter the level of consciousness, with effects similar to those of alcohol.
CNS
Treatment for sedative-hypnotic drugs is to ensure airway is patent, assist ventilations, and provide prompt _______.
transport
Some common agents of abused inhalants include:
acetone
toluene
xylene
hexane
Common agents of abused inhalants are often found in:
glues
cleaning compounds
paint thinners
lacquers
_________ and various halogenated hydrocarbons such as Freon, used as propellants in aerosol sprays, are also abused as inhalants.
Gasoline
Abused inhalants are commonly abused by _________.
teenagers
In abused inhalants, the _________ dose and the ________ dose are very close, making them extremely dangerous drugs.
effective
lethal
Halogentated hydrocarbon solvents can make the heart hypersensitive to the patient’s own _________.
adrenaline
With abused inhalants, even the act of ________ may cause a fatal ventricular dysrhythmia. Keep such patients from struggling and exerting themselves.
walking
__________ _______ is a highly toxic, colorless, and flammable gas with a distinctive rotten-egg odor.
Hydrogen sulfide
With hydrogen sulfide, poisoning usually occurs by ___________.
inhalation
Hydrogen sulfide affects all organs, but it has the most impact on the _____ and _____.
lungs
CHS
Hydrogen sulfide is used to commit suicide; referred to as __________ or _________ suicide.
chemical
detergent
____________ are CNS stimulants that mimic the effects of the sympathetic (fight-or-flight) nervous system.
Sympathomimetics
Sympathomometic stimulants frequently cause __________, ________ and _________ ________.
hypertension
tachycardia
dilated pupils
______________ examples include amphetamines, methamphetamines, phentermine hydrochloride, and amphetamine sulfate (Benzedrine).
Sympathomometic
________ may be taken in a number of different ways. It can be absorbed through all mucous membranes and even across the skin. Immediate effects include excitement and euphoria and last less than an hour. Smoked crack produces the most rapid means of absorption and, therefore, the most potent effect.
Cocaine
Synthetic cathinones are also called ______ _______.
bath salts
Methylenedioxymethamphetamine is also known as ________.
MDMA, ecstasy, or Molly
Brand names of MDMA include:
Ivory Wave and Cloud Nine
Synthetic cathinones users typically snort or insufflate the powder _______and effects reportedly last as long as _____ hours.
nasally
48
Nearly ________ of Americans have tried marijuana.
half
_____________, or (____), is the chemical in the marijuana plant that produces its high.
Tetrahydrocannabinol
THC
Ingestions of marijuana can lead to cannabinoid hyperemesis syndrome, characterized by chronic marijuana use and extreme nausea and vomiting that is relieved only by a ______ _______ or _______
hot shower
hot bath
____________ alter a person’s sensory perceptions
Hallucinogens
The classic hallucinogen is ________ _______ ________ (______).
lysergic acid diethylamide (LSD)
Anitcholinergic agents are medications that have properties that block the ____________ nerve.
parasympathic
Common drugs of anticholinergic agents include:
atropine
Benadryl
jimsonweed
amitriptyline (Elavil)
Death from anticholinergic agents can be rapid - the patient can go from appearing “normal” to seizure and death within _____ minutes.
30
____________ agents overstimulate normal body functions that are controlled by the parasympathetic nerves.
Cholinergic
Cholinergic agents include “nerve gases” designed for _______ _______ and ___________ ___________.
chemical warfare
organophosphate insecticides
Signs and symptoms of cholinergic drug poisoning are easy to remember with the mnemonic DUMBELS:
Diarrhea Urination Miosis (constriction of the pupils_ Bradycardia, bronchospasm, bronchorrea (discharge from the lungs) Emesis (vomiting) Lacrimation (tearing) Seizures, salivation, sweating
Sigs and symptoms of cholinergic drug poisoning are easy to remember with the mnemonic SLUDGEM:
Salvation, sweating Lacrimation Urination Defecation, drooling, diarrhea Gastric upset and cramps Emesis Muscle twitching/miosis
Your priorities after decontamination of a patient with cholinergic poisoning are to decrease the secretions in the ______ and _______.
mouth
trachea
The most common antidote kit is the _________ Auto-injector.
DuoDote
The DuoDote kit consists of a single auto-injector containing ___________ and ____________.
atropine
pralidoxime
Food poisoning is almost always caused by eating food contaminated by ________.
bacteria
There are two main types of food poisonings. They are:
the organism itself may cause disease
the organism may produce toxins that cause disease
One organism that produces direct effects of food poisoning is the ___________bacterium and is characterized by severe gastrointestinal 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.
Salmonella
The more common cause of food poisoning is the ingestion of powerful toxins produced by bacteria, often in leftovers and is called _________________ and symptoms usually start within 2-3 hours after ingestion or as long as 8-12 hours after ingestion.
Staphylococcus
The most severe form of toxin ingestion is __________.
botulism
___________ can result from eating improperly canned food.
Botulism
Botulism is caused by the spores of _________ bacteria growing and producing a toxin.
Clostridium
Symptoms of botulism are __________, and include blurring vision, weakness, difficulty speaking and breathing and is often fatal with symptoms developing within the first 24 hours after ingestion or as long as 4 days later.
neurologic
Irritation of the skin and/or mucous membranes is a problem with the common houseplant called ___________.
Dieffenbachia
