Chapter 22 Part 1 Flashcards
Poison
Any substance—liquid
Toxicology
The study of toxins
Toxin
A drug or substance that is poisonous to a human and causes certain adverse effects that can potentially lead to death.
Overdose
A poisoning in which the patient has been exposed to an excessive dose of a drug.
Substance Abuse
The inappropriate use of a substance or medication.
Ingestion
A route by which a drug or substance can be swallowed with absorption occurring through the gastrointestinal tract.
Inhalation
Breathing a poison—typically a gas
Injection
A route by which a poison can be injected under the skin
Pulmonary Edema
Fluid leaking around and into the alveoli
Bronchospasm
Contraction of the muscles in the bronchi and bronchioles
Local Reaction
A reaction to a poison that typically causes edema (swelling) at the site of injection
Systemic Reaction
A reaction that can occur from injection of a poison
Accidental Poisoning
Poisonings that are unintentional and often involve young children.
Household Chemicals
Substances that are most often involved in unintentional or accidental poisonings.
Homicide
Intentional poisonings that result in the death of another person.
Suicide
Intentional poisonings that result in the death of the individual.
Gastrointestinal Tract
The system in the body through which ingested substances are absorbed
Alveoli
Tiny air sacs in the lungs where gas exchange occurs
Edema
Swelling caused by excess fluid trapped in the body’s tissues.
Signs and Symptoms
Indicators of poisoning that can vary based on the route of exposure and type of poison.
Respiratory Distress
Severe difficulty in breathing that can indicate the presence of an inhaled poison.
Delayed Effect
A situation where the signs and symptoms of poisoning may not present for several hours after exposure.
Acid Poisoning
Poisoning caused by contact with strong acids
Injection Poisonings
Poisonings that can result from drug use or from bites and stings.
Hymenoptera
An order of insects that includes bees
Anaphylactic Reaction
The most severe type of allergic reaction that can result from injection of venom.
Absorption
The process by which a poisonous substance can enter the body when it contacts the skin or mucous membranes.
Severe Absorption Poisoning
Results from pesticides and other lethal substances that contact the skin.
Organophosphates
Commonly found in certain pesticides
Toxidromes
Signs and symptoms of poisoning that depend on the specific poison and the route of entry into the body.
Bradycardia
A condition that might occur from poisoning
Tachycardia
A condition that might occur from poisoning
Tachypnea
A condition that might occur from poisoning
Hypotension
A condition that might occur from poisoning
Hypertension
A condition that might occur from poisoning
Corrosive Poison
A type of poison that can cause burns to the lips and inside the mouth.
Patent Airway
An airway that is open and unobstructed
Positive Pressure Ventilation
A method provided for inadequate breathing to maintain adequate oxygenation.
Lateral Recumbent Position
The position in which a patient is placed to closely monitor the airway after ingestion of poison.
Mental Status Deterioration
A sudden decrease in mental status that can indicate rapid patient deterioration.
Emergency Care
Supportive care that must be established and maintained regardless of the poison or route.
Reassessments
Necessary actions to monitor the breathing status and prepare to ventilate if necessary.
Vomiting
A common occurrence in persons poisoned by ingestion
Aspiration of vomitus
The act of inhaling vomit into the lungs
Antidote
A substance that neutralizes the effects of the poison or toxic substance.
True antidotes
Antidotes that are available for only a small number of poisons.
Treatment of poisons
Generally limits or prevents the absorption of the poison and manages any other signs and symptoms.
Supportive care
Care that supports the airway
ALS unit
An Advanced Life Support unit that can have medications to reverse the effects of certain toxins.
Naloxone (Narcan)
A drug that can reverse the effects of a narcotic (opioid) overdose.
Ingested poison
A poison that is swallowed and enters the gastrointestinal system.
Absorption of poison
Most of the absorption occurs in the small intestine
Common causes of accidental ingestion
Taking too much prescribed medication
Poisonous plants
Common household and backyard plants that can cause poisoning
Scene size-up
The process of observing clues indicating an ingested poisoning during the assessment.
Primary assessment
A vital step in managing the poisoned patient that can provide clues about the time since ingestion.
Altered mental status
A change in mental state that indicates the poison is absorbed into the bloodstream and having systemic effects.
Common poisonous substances
Prescription medications
Poisonous mushrooms
A high number of poisonings result from eating wild mushrooms.
Signs of poisoning
Clues such as overturned medicine bottles
Gastrointestinal system
The system that ingests poisons
Time since ingestion
Determining this can change the treatment the patient receives.
Poisoning emergencies
Commonly occur due to accidental ingestion
Household products
Common items that can be poisonous
Positioning and suctioning
Methods to prevent aspiration of vomitus in a poisoned patient.
Monitoring of airway
Close observation of the airway to prevent complications in a poisoned patient.
Alert and Oriented
Indication that the poison has not yet been absorbed in a large quantity or that a large quantity was not ingested by the patient.
Altered Mental Status
A condition that necessitates opening and clearing the airway.
Lateral Recumbent Position
Position to reduce the possibility of aspiration in a patient with altered mental status.
Oropharyngeal Airway
Device that may need to be inserted to effectively ventilate a poisoned patient.
Nasopharyngeal Airway
Another device that may be inserted to effectively ventilate a poisoned patient.
Inadequate Breathing
A condition that requires assessment of respiratory rate and quality.
Positive Pressure Ventilation
Intervention provided with a bag-valve mask or other ventilation device if respiratory rate or depth is inadequate.
Hypoxia
Condition that may require administration of oxygen via a nasal cannula.
Hypoxemia
Condition that may require administration of oxygen via a nasal cannula.
Poor Perfusion
Condition that may require administration of oxygen via a nasal cannula.
Cardiopulmonary Resuscitation Protocol
Action to proceed with if the pulse is absent.
Secondary Assessment
Most information about an ingested poisoning is obtained during this phase.
Common Poisons in Children
Plants
Pupils and Skin Condition
Two extremely important areas to examine during the assessment of a poisoning patient.
Liquid Acid Ingestion
Likely to cause more severe tissue damage to the stomach lining than to the esophagus.
Ingested Alkali Substances
Cause more severe damage compared to liquid acids.
Patient History
Information that is crucial for managing a poisoning patient but may be difficult to obtain accurately.
Intentional Overdose
A scenario where the patient may be misinformed or trying to deceive regarding their history.
Accidental Death Cause in Children
Poisoning is the number one cause.
Respiratory Drive Depression
Many poisons can lead to this condition
Chest Rise and Fall Monitoring
Important to closely monitor in a poisoned patient.
Skin Temperature
Color
Substance Ingestion
The act of taking in a substance
Alcohol Ingestion
The consumption of alcohol with a substance
Time of Ingestion
The timing of when the patient ingested the poison
Duration of Exposure
The span over which the substance was ingested or the patient was exposed
Amount of Substance Taken
The quantity of the substance ingested
Previous Treatment Attempts
Any prior attempts to treat the poisoning
Psychiatric History
The patient’s mental health background that may suggest a possible suicide attempt.
Underlying Medical Conditions
Existing health issues
Patient Weight
The patient’s weight
Available Medications
Medications present in the house that could indicate the source of poisoning.
Physical Exam
An assessment of the patient’s body systems and areas of complaint to identify abnormalities.
Vital Signs
Measurements of physiological functions that have limited role in assessing poisoning severity.
Signs and Symptoms of Poisoning
Indicators of poisoning that can vary based on the ingested substance.
History of Ingestion
Documentation of the patient’s past consumption of substances.
Swelling of Mucosal Membranes
Inflammation in the mouth caused by caustic substances.
Nausea
A feeling of sickness with an inclination to vomit.
Vomiting
The act of expelling the contents of the stomach through the mouth.
Diarrhea
Frequent and watery bowel movements
Altered Mental Status
Changes in consciousness or cognitive function due to poisoning.
Abdominal Pain
Discomfort in the abdominal area
Burns or Stains Around the Mouth
Injuries or discoloration around the mouth caused by corrosive poisons.
Unusual Breath Odors
Distinct smells on the breath that can indicate specific ingested toxins.
Toxin
Odor
Hydrogen sulfide
Rotten eggs
Naphthalene
camphor
Cyanide
Bitter almonds
Acetone
isopropanol
Organophosphates
Garlic
Petroleum distillates
Gasoline
Chloral hydrate
Pears
Methyl salicylate
Mint
Phosgene
Fresh mowed hay
Respiratory distress
A condition indicating difficulty in breathing.
Altered heart rate
Tachycardia or bradycardia.
Altered blood pressure
Hypertension or hypotension.
Dilated or constricted pupils
Changes in pupil size indicating possible poisoning.
Warm and dry or cool and moist skin
Skin condition changes that may indicate poisoning.
Seizures
Sudden
Activated Charcoal
A medication occasionally used in the emergency medical care of ingested poisonings.
Oropharyngeal airway
A device used to maintain an open airway.
Nasopharyngeal airway
A device used to maintain an open airway in unresponsive patients.
Positive pressure ventilation
Ventilation method using a bag-valve-mask with supplemental oxygen.
Nasal cannula
A device used to deliver supplemental oxygen.
Lateral recumbent position
A position to place a patient to prevent aspiration in case of vomiting.
Reassessment
The process of evaluating a patient’s condition after initial care.
Poison control center
A resource for information on managing poisonings.
Activated Charcoal
A special distilled charcoal that has been treated with superheated steam
Administration of Activated Charcoal
Should be administered as early as possible and only in specific cases approved by medical direction.
Indications for Activated Charcoal
May be used for a patient who has ingested poison by mouth
Contraindications for Activated Charcoal
Should not be administered to a patient who has an altered mental status
Dosage of Activated Charcoal
Unless directed otherwise
Usual Adult Dose of Activated Charcoal
The usual adult dose is 25-50 grams.
Usual Dose for Infants and Children of Activated Charcoal
The usual dose for infants and children is 0.5-1 gram per kilogram.
Forms of Activated Charcoal
Available as premixed in water or as a powder
Trade Names of Activated Charcoal
Some trade names include SuperChar
Efficacy of Activated Charcoal
It is intended to limit the amount of poison absorbed by the intestines due to its capability to adsorb poison while it is still in the stomach or proximal portion of the intestines.
Activated Charcoal Appearance
Activated charcoal looks like mud.
Patient Administration Tips
The patient may be more willing to drink it if it is not visible
Record Keeping
Record the time and the patient response after administering activated charcoal.
Repeat Dose Notification
If the patient vomits
Activated Charcoal Particle Size
Activated charcoal is produced to have a small particle size to increase its adsorptive properties.
Surface Area Comparison
A standard dose of activated charcoal has roughly the same surface area as football fields.
Laxative Agent in Activated Charcoal
Some activated charcoal products contain a laxative agent (cathartic) that helps speed it through the intestinal tract.
Medical Direction
Consult medical direction or the poison control center before administering activated charcoal to any patient.
Preparation of Activated Charcoal
Shake the container thoroughly; if too thick
Settling of Activated Charcoal
If the activated charcoal settles
Poison Control Center
Follow your protocol
Limited Use of Activated Charcoal
Due to its limited efficacy
Activated Charcoal
A substance that adsorbs poisons in the stomach
Effectiveness of Activated Charcoal
Decreased by milk
Common Side Effect of Activated Charcoal
Blackening of the stools.
Vomiting After Activated Charcoal Administration
If the patient vomits
Administration Precautions
Ensure the patient’s airway and mental status are adequate to prevent aspiration.
Contraindications for Activated Charcoal
Do not administer to patients with altered mental status
Use of Activated Charcoal in Prehospital Environment
Use activated charcoal that has been premixed with water.
Common Brands of Activated Charcoal
Contain activated charcoal mixed with water in a plastic bottle.
Powdered Activated Charcoal
Must be mixed with water before administration; discouraged in the field due to preparation issues.
Inhaled Poisons
Toxic substances absorbed rapidly by the body
Common Inhaled Poisons
Include carbon monoxide
Huffers
Patients who inhale paints and propellants to achieve a high.
Effects of Inhaled Toxins
Can lead to hypoxia by displacing oxygen in the alveoli
Signs of Toxic Inhalation
Look for paint or other material on the lips or around the nose during the physical exam.
Activated Charcoal Administration Guidelines
Only administer based on medical direction and/or poison control center advice.
Activated Charcoal Absorption Limitations
Not effective for alcohol
Patient Positioning During Administration
Place the patient in a sitting or lateral recumbent position to prevent aspiration.
Reassessment During Administration
Check for abdominal pain or distress and watch for possible vomiting.
Premixed Activated Charcoal
Recommended for use in the prehospital environment.
Toxic Inhalation Prognosis
The longer the exposure without treatment
Common Sources of Inhaled Poisons
Include industrial sites
Anesthetic Gases
Include ether
Incomplete Combustion of Natural Gas
A source of inhaled poisons that can lead to toxic exposure.
Hydrogen Sulfide
Also known as sewer gas
Nitrogen Dioxide
A toxic gas that can be produced from fermented grain.
Commonly abused inhaled poisons
Paints
Onset of inhaled poisons
Inhaled poisons typically have a more immediate onset than injected poisons.
Effects of inhaled poisons
Inhaled poisons can destroy lung tissue
Damage caused by inhaled toxins
An inhaled toxin can directly damage the alveoli when inhaled
Signs and symptoms onset
Inhaled poisons often cause a rapid onset of signs and symptoms due to rapid absorption into the lungs and circulation.
Carbon monoxide poisoning presentation
Young children and the elderly typically present with signs and symptoms of carbon monoxide poisoning before any other patients who have been exposed.
Scene size-up importance
Ensuring your safety is of prime importance during the scene size-up.
Peculiar odors and visible fumes
You should be acutely aware of peculiar odors or visible fumes during the scene size-up.
Odorless gases
Some gases
Self-contained breathing apparatus
Wear self-contained breathing apparatus before entering the scene if toxic fumes are present.
Hazardous materials rescue
If you are not properly equipped or trained for hazardous materials rescue
Assessing inhaled poison patients
Determine the number of persons at the scene who might have inhaled the poison; there are likely to be more patients than the one for whom EMS was originally called.
Patient removal from toxic environment
Have trained rescuers remove the patient from the toxic environment.
Primary assessment focus
Close assessment and management of the patient’s airway and ventilation status is important in inhaled poison patients.
Altered mental status
If the patient has an altered mental status
Ventilation assistance
If the rate is inadequate or the tidal volume is inadequate
Maximizing oxygenation
Maximize oxygenation of the patient during ventilation by connecting oxygen to the ventilation device.
High concentration oxygen administration
If breathing is adequate in both rate and depth
Monitoring inhaled poisoning patients
Monitor the patient closely because he can deteriorate rapidly and begin to breathe inadequately.
Assessing circulatory status
Assess the patient’s circulatory status by assessing the pulse and the skin color
Secondary Assessment
During the secondary assessment
History
Ask the patient or bystanders questions about what was inhaled
Suicide Attempt History
Does the patient have a history that suggests a possible suicide attempt? This is more common in apparently intentional carbon monoxide poisonings.
Exposure Location
Did the exposure occur in an open or a confined space? A confined space likely has highly concentrated amounts of the toxin and can lead to a severe toxic exposure.
Duration of Exposure
How long was the patient exposed? The severity of the inhaled poisoning is associated with the duration of exposure to the toxin.
Fire Exposure
Patients who are trapped in a fire are typically exposed to large amounts of toxic substances.
Incomplete Combustion
Incomplete combustion of products releases toxic fumes
Common Causes of Death in Fire
Most people who die in a fire do so from inhalation of toxic fumes and not from burns.
Airway Injuries
The second most common cause of death in a fire is from airway injuries secondary to breathing in superheated air.
Trauma in Fire
The third most common cause of death in a fire is from trauma.
Physical Exam
If the patient is responsive enough to provide you with an adequate history
Vital Signs
Obtain and record the patient’s vital signs.
Signs and Symptoms of Inhaled Poisoning
Following are the signs and symptoms of inhaled poisoning: A history of inhalation of a toxic substance
Signs of Respiratory Tract Burns
Signs of respiratory tract burns include: Singed nasal hairs
Emergency Medical Care
Respiratory symptoms are typically the first to appear with inhalation injuries.
Protecting from Toxic Fumes
Protect yourself from exposure to toxic fumes by wearing self-contained breathing apparatus or waiting for a specialized team to make the rescue.
Patient Positioning
Place the patient in a supine position or position of comfort. Loosen all tight-fitting clothing
Open Airway
Establish and maintain an open airway.
Positive Pressure Ventilation
Start positive pressure ventilation with supplemental oxygen immediately if the patient has an inadequate tidal volume or respiratory rate.
High Concentration Oxygen
Administer a high concentration of oxygen by nonrebreather mask initially for all inhaled poisoning patients regardless of the reading.
Reassessment
Provide a reassessment en route to the hospital with attention to the patient’s airway and breathing.
Injected Poisons
An injected poison is one that enters the body through a break in the skin
Injected Poisons
Substances that can be introduced into the body through various means such as bites
Anaphylactic Shock
A severe allergic reaction that can occur following an insect bite or sting.
Common Sources of Injected Poisons
Includes stings from bees
Immediate Reaction
The initial response at the injection site following exposure to injected poisons.
Delayed Systemic Reaction
A later response that affects the body after the initial reaction at the injection site.
Assessment-Based Approach
A systematic method to evaluate and provide emergency care for injected poisoning cases.
Scene Size-Up
The initial evaluation of the environment for clues related to injected poisoning.
Primary Assessment
The first step in evaluating a patient’s condition
Pathophysiology of Injected Poisons
Injected poisons are absorbed into capillaries and can affect multiple organs throughout the body.
Secondary Assessment
A detailed evaluation that includes obtaining a history and vital signs from the patient or bystanders.
History Questions for Injected Poisons
Questions to ask include history of drug use
General Signs and Symptoms of Toxic Injection
Includes weakness
Emergency Medical Care for Toxic Injection
Involves protecting oneself and the patient from further injury and moving the patient away from any remaining threats.
Weakness/Lethargy
A common symptom indicating reduced energy or responsiveness in a patient.
Dizziness
A feeling of lightheadedness or unsteadiness often associated with toxic injection.
Chills
A sensation of coldness that may occur as a symptom of injected poisons.
Fever
An elevated body temperature that can be a response to injected toxins.
Nausea/Vomiting
Gastrointestinal symptoms that may arise following toxic injection.
Euphoria
An exaggerated feeling of well-being that can occur with certain toxic injections.
Sedation
A state of calm or drowsiness that may result from injected poisons.
High or Low Blood Pressure
Variations in blood pressure that can indicate a reaction to injected poisons.
Pupillary Changes
Alterations in pupil size that may occur as a symptom of toxic injection.
Skin Abscesses
Localized infections that can develop at the site of injection.
Pain at the Site of Injection
Discomfort experienced where the poison was introduced into the body.
Bees
Can sting only once and then lose their stinger.
Wasps
hornets
Oropharyngeal airway
Inserted if the patient does not have a gag reflex.
Nasopharyngeal airway
Used if the patient has a depressed mental status but does not accept an oropharyngeal airway.
Positive pressure ventilations
Begun with supplemental oxygen if the patient’s respirations are inadequate.
Adequate oxygenation
Administer oxygen via a nasal cannula to achieve and maintain an oxygen saturation of 94% or greater.
Lateral recumbent position
Position to help prevent aspiration in case of vomiting.
Absorbed poison
Usually a chemical or substance from a poisonous plant that enters through the skin.
Skin reactions from absorbed poisons
Range from mild irritation to severe chemical burns.
Hydrofluoric acid exposure
Exposure of as little as 1% of the body surface can cause death.
Scene Size-Up
Make note of any open containers of chemicals or poisonous plants in the environment.
Primary Assessment
Carefully assess the patient’s airway and breathing.
Secondary Assessment
Get a history from the patient or bystanders about the toxic substance that is likely to have been absorbed.
History and Physical Exam
Obtain and record the patient’s vital signs.
Suction
Used for vomitus or secretions.
Reassessment
Provide attention to the airway and breathing and monitor for possible development of an anaphylactic reaction.
Emergency care for poisoning
Follow steps of assessment to determine facts surrounding a possible absorbed poisoning.
Protective gear
Wear gloves and other protective gear to ensure harmful substances do not contact your skin.
Toxic substance
Take care to avoid contact with the toxic substance during assessment.
Muscle paralysis
Some absorbed poisons can cause this and compromise the patient’s respiratory status.
Excessive secretions
Can complicate the airway in cases of absorbed poisoning.
Altered mental status
Secondary to the effects of the absorbed poison could cause the jaw and tongue to relax and block the airway.
Vital signs
Should be obtained and recorded during the physical exam.
Signs and Symptoms of Absorbed Poison
A history of exposure to a poisonous substance
Signs and Symptoms of Contact with a Poisonous Plant
Fluid-filled
Emergency Medical Care for Absorbed Poison
Protecting your hands with gloves
Positive Pressure Ventilations
Begin positive pressure ventilations with supplemental oxygen if the patient’s respirations are inadequate.
Oxygenation Maintenance
Maintain adequate oxygenation. If there are signs of respiratory distress
Brushing Off Dry Chemicals
Brush any dry chemicals or solid toxins from the patient’s skin
Flushing Contaminated Area
Contact medical direction to determine whether to flush the contaminated area.
Irrigation of Liquid Poison
If the poison is liquid
Irrigation of Eye with Poison
If the poison entered the eye
Positioning During Eye Irrigation
Position the patient so water runs away from the unaffected eye
Reassessment During Transport
Provide a reassessment en route to the hospital with attention to the status of the patient’s airway and breathing.
Assessment Summary for Poisoning Emergency
The following findings may be associated with a poisoning emergency.
Scene Size-Up for Poisoning
Is the poisoning due to ingestion
Mechanism of injury
The process or event that caused the injury.
Alcohol
drugs
Empty medicine bottles
Containers that previously held medications
Spilled chemicals
cleaning solvents
Pieces of plants
Plant material that may indicate exposure to toxic flora.
Position and location of the patient
The physical placement of the patient
Confined spaces
Enclosed areas that may increase the risk of exposure to toxic substances.
Peculiar odors
Unusual smells that may indicate the presence of toxic substances.
More than one patient with similar signs and symptoms
Indicates a potential mass exposure to a harmful substance.
Drug paraphernalia
Items associated with drug use that may indicate substance abuse.
Insects
snakes
Powdered or liquid substance on the skin surface
Indicates possible exposure to toxic materials.
Paint or other chemicals on the patient’s lips or around the nose
May suggest inhalation or ingestion of harmful substances.
Primary Assessment
Initial evaluation to determine the patient’s condition.
General Impression
Overall assessment of the patient’s appearance and condition.
Burns to skin from chemical exposure
Injuries resulting from contact with harmful chemicals.
Vomitus or secretions in mouth
Presence of expelled contents that may indicate poisoning.
Stings or bites to body with areas of swelling
Injuries that may indicate exposure to venomous creatures.
Mental Status
Assessment of the patient’s consciousness and cognitive function.
Airway
The passage through which air enters and leaves the lungs.
Breathing
The process of inhaling and exhaling air.
Circulation
The movement of blood throughout the body.
Status: Priority Patient
Indicates a patient requiring immediate medical attention.
Secondary Assessment
Further evaluation after the primary assessment to gather more information.
History
Information regarding the patient’s past medical and exposure history.
Physical Exam
A thorough examination of the patient’s body to identify injuries or symptoms.
Vital Signs
Measurements of essential body functions
Emergency care protocol: poisoning emergency
Guidelines for managing patients with suspected poisoning.
Open Airway
Establish and maintain unobstructed airflow for patient.
Positive Pressure Ventilation
Assisted breathing for inadequate respiratory function.
Nonrebreather Mask
Delivers high concentration oxygen to patients.
Lateral Recumbent Position
Patient lying on their side for airway protection.
Ingested Poison
Toxins consumed, requiring airway and ventilation support.
Inhaled Poison
Toxins breathed in, necessitating oxygen supply.
Injected Poison
Toxins introduced via needle or sting, requiring scraping.
Absorbed Poisoning
Toxins absorbed through skin, requiring decontamination.
Food Poisoning
Illness from consuming contaminated food or toxins.
