Chapter 22

Question 1

chemicals that contact the skin, mucus membranes or eyes have the potential to cause severe damage. Alkalis, acids and hydrocarbons are some of the most destructive.

• signs and symptoms (s/s) of such poisonings include a history suggestive of this, irritated skin, erythema of the skin or bullae (blisters) present on the skin. .
• emergency treatment involves removing the offending chemical by first, preventing self-contamination and secondly diluting with copious amounts of water. If the patient is wearing clothing – REMOVE IT. Flush with water for 10 minutes if contact is on the skin.
• if the patient has chemical exposure in the eyes irrigation should be at least 10 minutes for acid substances and 20 minutes for alkali substances. If you are unsure, irrigate for 20 minutes.
• the only time irrigation is contraindicated is if a potential harmful reaction may occur from contact with water. Examples include phosphorous and elemental sodium.
• provide prompt transport to the emergency department. Irrigate while in route if necessary.

Answer 1

ABSORBED POISIN

Question 2

a substance that absorbs poisons from the GI tract

Don’t use if
altered mental status
ingested acids or alkalis (hydrochloric acid bleech, ammonia, ethyl alcohol

Answer 2

activated charcoal

Question 3

a substance which can counteract a form of poisoning

Answer 3

antidote

Question 4

Drugs that can be used to slow down brain activity

includes a category of drugs and medicines categorically known as barbiturates and benzodiazepines.

• s/s
  are similar to EtOH intoxication.
• these substances are lethal when used in combination with alcohol (EtOH).
• these drugs are also touted to be given to people as “knock-out” drugs or “date rape drugs.” Rohypnol is one such example.
• general treatment
  airway support, ventilatory assistance, and transport to the emergency department for continued ventilatory support. Always administer supplemental oxygen.
• an antidote – romazicon – can be administered by paramedics.

Answer 4

Central nervous system (CNS) depressants

Question 5

(substances that produce an excited state) causing hypertension (HTN), tachycardia and dilate the pupils.

• examples include amphetamines, methamphetamines, phentermine, caffeine, phenylpropanolamine (nasal decongestants), and pseudoephedrine (nasal decongestants).
• cocaine and crack are the classic sympathomimetics though recently ecstasy – a so-called “designer drug” – has become increasingly abused in certain areas of the United States.
• designer drugs can be ingested, inhaled and injected.
• s/s
  include disorganized behavior, restlessness, delusions, paranoia. Effects of the medication last less than one hour usually.
• the risk of cardiac arrhythmia and stroke is also high – particularly with cocaine or crack. EMT’s may see extremes of HTN and seizures.
• treatment includes oxygen, IV establishment if possible and be prepared to suction and protect the airway.

Answer 5

CNS stimulants

Question 6

alter one’s sense of perception.

• two common hallucinogens include LSD and PCP.
• s/s include visual hallucinations and intensify auditory and visual senses.
• many of the hallucinogens have sympathomimetic properties therefore treatment usually invokes a calm manner and providing emotional support.

Answer 6

hallucinogens

Question 7

Inhalant abuse, also known as “huffing,”

toluene, a commonly inhaled solvent.

Answer 7

huffers

Question 8

approximately 80% of all poisoning is by mouth; ingested products include household products, food, plants and in the majority of cases… drugs.

• children are poisoned most frequently and the most common products they are poisoned with are household products.
• if an ingested poison is suspected the EMT’s job is to first assess Airway, Breathing, Circulation and Disability (ABCD). If this appears stable, you should attempt to remove as much poison as possible. This can be accomplished in several ways but a common method used in many EMS agencies is activated charcoal.

Answer 8

ingested poison

Question 9

are almost always the result of substance abuse. Heroin and cocaine top the list… but injected poisons can also be the result of bites and stings.

• signs and symptoms (s/s) vary in every patient but common s/s include weakness, dizziness, altered mental status, excitability, or unresponsiveness.
• are difficult for EMT’s to treat since dilution is difficult. Some medications can be given in certain circumstances that counteract the effects of some drug-induced poisoning but quick transport to the hospital is the key to effective treatment.
• EMT’s should be prepared to use Basic Life Support (BLS) skills.

Answer 9

injected poison

Question 10

named so due to its origin from the poppy seed.

Include such drugs and medicines as heroin, codeine, and morphine, demerol, dilaudid, percocet, vicodin and methodone.

• these substances are CNS depressants and result in severe CNS depression.
• s/s
  include “sedated” patients, occasionally they are cyanotic and have pinpoint pupils.
• treatment includes supporting ABC, administering supplemental oxygen, being prepared for vomiting and dilution with IV fluids.
• an antidote for narcotics include a powerful narcotic-antagonist called Narcan – usually administered by paramedics – that will reverse the “high” in as little as two-minutes

Answer 10

narcotics

Question 11

describes the ingestion or application of a drug or other substance in quantities greater than are recommended or generally practiced.[

Answer 11

overdose

Question 12

when kids rad their parents medicines

Answer 12

pharming

Question 13

any substance that when introduced into the body in substantial amounts causes harm.

• can be something as simple as water if consumed in excess or it can be something like inhaled cyanide which takes very minute amounts to kill.
• work by altering cell metabolism in such a way that is causes harm.
• may act acutely, such as a heroin overdose, or over years such as with alcohol abuse.
• signs and symptoms are an important clue to identifying a patient that has been poisoned. Ingested poisons, for example, may result in injury to the mouth.
• if a patient vomits, collect the vomitus and bring it to the hospital so that it can be examined. In addition, if you suspect overdose of pills or medicines, brings those to the hospital as well.

Answer 13

poison

Question 14

the study of the adverse effects of chemical, physical, or biological agents on people, animals, and the environment.

Answer 14

toxicology

Question 15

a poisonous substance produced within living cells or organisms.

Answer 15

toxins

Question 16

s/s are similar to the CNS effects seen with sedative-hypnotic but the route is via inhalation vs. ingestion or infection.

• include acetone, hexane (found in glues), paint thinner, hydrocarbons (found in gasoline or other petroleum products), propellants found in aerosol sprays.
• drowsiness is a common finding, but seizures can also occur with the use of this substance.
• patients that inhale hydrocarbons can make the heart sensitive to the patients own adrenaline putting them a risk for sudden cardiac death; try to keep such patients from struggling or exerting themselves.
• treatment should always include supplemental high-flow oxygen and use stretches to move these patients.
• transport to a hospital is always recommended.

Answer 16

volatile inhalants

Question 17

3.period of fighting addiction: a period during which somebody addicted to a drug or other addictive substance stops taking it, causing the person to experience painful or uncomfortable symptoms

Answer 17

withdrawals

Question 18

include several substances including natural gas – the most common accidental inhaled poison – pesticides, chlorine, smoke and others.

• all patients should be moved into an environment where there is fresh air. Supplemental oxygen should also be provided for those suspected of inhaling a poison. .
• signs and symptoms may include burning or watery eyes, sore throat, cough, hoarseness, respiratory distress, stridor, pulmonary edema, seizures and altered mental status. Remember, signs and symptoms need not be immediate… therefore, if an inhaled poison is suspected, ALL patients require transport to the hospital.
• EMT’s should be prepared to use Basic Life Support (BLS) skills.

Answer 18

inhaled poison

Question 19

most commonly abused drug in the United States contributing to more than 200,000 deaths each year.

• EtOH is a powerful CNS depressant that sedates (to decrease the activity of) and is a hypnotic (induces sleep).
• EtOH dulls the senses, slows reflexes, reduces reaction time, and reduces coordination.
• signs and symptoms
  Periods of CNS depression may result in a patient vomiting without even knowing s/he has vomited… so ALWAYS PROTECT THE AIRWAY in these patients.
• a patient with EtOH withdrawl may experience delirium tremors (DT’s) – syndrome characterized by restlessness, fevers, sweating, chills, delusions, hallucinations, agitation and seizure activity.
• overall treatment for patients suspected of EtOH abuse is to dilute with oral or IV fluid and to provide BLS support. Protect the airway by having suction devices ready and turing patients to their side.

Answer 19

Alcohol (EtOH)

Question 20

these drugs block the parasympathetic nervous system.

• common medications include benadryl and tricyclic antidepressants.
• s/s include tachycardia, agitation and pupil dilation. Serious side effects include cardiac arrhythmia’s and seizures.
• treatment for such serious side effects include sodium bicarbonate intravenously otherwise monitoring is necessary in a hospital environment.

Answer 20

Anticholinergics

Question 21

are the “nerve gases” used in chemical warfare.

• the mechanism by which they act upregulate the parasympathetic nervous system.
• normally found in insecticides or some wild mushrooms.

 - s/s 
are easily remembered by the acronym SLUDGE
      - salivation
      - lacrimation
      - urination
      - defecation
      - GI irritation
      - eye constriction

• patients exposed to cholinergic actions frequently require decontamination by HAZMAT units.
• treatment include IV atropine and aggressive airway support.

Answer 21

cholinergic agents

Question 22

two of the more common medications that can lead to lethal conditions include aspirin (ASA) and tylenol (acetaminophen - APAP).

• over-ingestion of ASA can result in nausea and vomiting and tinitus (ringing in the ears). Serious side effects include lowering the pH of the body to lethal levels resulting in tachyarrhthymias or kidney failure.
• over-ingestion of APAP leads to liver failure… the problem is, it may not be apparent for over a week and the patient may be symptom free until that time. If information about the overdose is obtained early enough, a antidote may minimize and in some cases prevent liver failure.

Answer 22

over the counter

Question 23

there are two main types. In one type, the organism is responsible for the disease process; in the other type, the organism produces a toxin which then causes the disease.

• Salmonella is one example in which the organism causes the disease process.
• s/s
  of salmonellosis is characterized by nausea, vomiting, abdominal pain, diarrhea, fever and generalized weakness.

It occurs within 72 hours of eating and is common when eating improperly cooked poultry.

• Staphylococcus is an example where the organism produces a toxin that causes the disease process.
• s/s include nausea, vomiting, and diarrhea starting within 2-3 hours after ingestion of the offending organism.
• this type of poisoning commonly occurs when eating food that are prepared in advance and kept unrefrigerated.
• treatment includes supportive care until IV fluids and medications can be administered.

Answer 23

Food Poising

Question 24

thousands of cases each year due to contact or ingestion.

• though it is impossible to memorize all plants that can cause harm, two common offending organisms are listed below – poison ivy and poison oak.
• treatment include maintaining an open airway and monitor vital signs, notifying the regional Poison Control Center (PCC) below to identify the plant, taking the patient and the plant to the Emergency Department and transporting the patient to the hospital.

Answer 24

plant Poisoning

Question 25

CO-an odorless, colorless, two-molecule gas produced by burning material containing carbon-accounts for greater mortality and morbidity than all other poisonings combined

S/S
Tachypnea
headaches
nausea and vomiting
High pulse oximeter reading 

Treatment
150 away from source
tight nonrebreather mask 15lpm
transport immediately

Answer 25

carbon monoxide poising

Question 26

potentially deadly poison. It works by making the body unable to use life-sustaining oxygen.

S/S:
headache
confusion
Agitation
Dyspnea
Bradycardia or Tachycardia
Smell of bitter almonds
Seizure
coma
hypotension
pulmonary edema
acidosis

Care:
1. remove from toxic environment
2. remove contaminated clothing and decontaminate patient
3.open/maintain airway
4. assess breathing
    15lmp nonrebreather
     PPV with sup oxygen
5. consider als
6. rapid transport

Answer 26

Cyanide poisoning

Question 27

When a substance dissolves in water it makes a
ommon in many household products

__________has high Ph

____________burns on contact

S/S:
Burns to mouth/lips
dysphagia (difficult swallowing, drooling)
Pain to lip mouth and throat
Stidor
shock

Care:
1.bsi
2.remove contaminated clothing, decontaminate patient, flush large amounts of water
3. maintain airway 
4. Assess breathing 
     15lmp nonrebreather
      PPV with max O2
5. rapid transport

Answer 27

Alkalis and acids