EAC Poisons and Substance Abuse Flashcards
define:
Poison
A poison is any substance which, when taken into the body in sufficient quantity, may either endanger life or seriously impair body functions
can be: Intentional, accidental and non-accidental
4 routes of poisons entry
Inhalation - gases or fumes
Ingestion - liquids or solids
Injection - needles or bites
Absorption - through eyes or skin (mucosa)
define:
Dependency
The physical and/or psychological effects produced by the habitual taking of certain drugs, characterised by a compulsion to continue taking the drug.
define:
Addiction
Addiction is a state characterized by compulsive engagement in rewarding stimuli, despite adverse consequences.
define:
Tolerance
the reduction or loss of the normal response to a substance that usually provokes a reaction in the body
poisons are classified as
corrosive/irritant
non-corrosive - neurotoxic poisons (drugs), poisonous gases (CO), paraquat poisoning
signs and symptoms of:
corrosive/irritant substances
lips and mouth show signs of corrosion (burning) and/or staining
Severe pain and swelling in the mouth and throat
Wretching, followed by vomiting
Abdominal cramps and diarrhoea
Difficult speech due to swelling of the mucosa
Odours on breath
signs and symptoms of:
Non-Corrosive substances
Pinpoint pupils
Slow and shallow breathing (depressed respiration)
Lethargy and reduction in activity
Vomiting and diarrhoea
Loss of consciousness
time critical elements associated with poisoning and overdose
LOC Respiratory depression/arrest Cardiac arrest Compromised airway Heat stroke
commonly abused drugs
Stimulants: amphetamines, ecstacy, cocaine
Depressants: cannabis, alcohol, opiates (heroin, morphine, codeine, opium), tranquilisers (diazepam, valium)
Hallucinogenic: LSD, magic mushrooms, PCP
Solvents: adhesives, aerosols, solvents, gases, cleaning agents
effects of:
Stimulants
Excitability and euphoria Hypertension Tachycardia Dilated pupils Sweating/hyperpyrexia Convulsions/unconsciousness
effects of:
Depressants
Anti depressants Shallow respirations Cool, clammy skin Dilated pupils (except in opiates - pinpoint) Decreasing LoC
effects of:
Hallucinogens
Vivid visual hallucinations Delusions Rapid mood swings Fear, panic and potentially violent Hypertension and tachycardia Effects may last up to 12 hours possibility of seizures
considerations when dealing with:
Solvents
Irritation to skin around nose and mouth Apparent intoxication Hallucinations Coma Asphyxia Rapid irregular pulse Cardiac arrest Damage to lungs and alveoli Pulmonary oedema Suffocation Toxic effect on heart, lungs, kidneys and brain Accidental death form falls
considerations when dealing with:
Alcohol Intoxication
Has the potential to mask serious injuries and illnesses
Risk of vomiting and aspiration
Often they don’t think they need to go to hospital
correct procedure when dealing with poisoning/overdose
Contact CHUB to use toxbase information required: Substance taken Quantities and strength When With what Vomited? Weight or build Gender Age
management of:
Corrosive/Irritant substances
DRABCDE
Time critical if A/B problems
O2 (not for paraquat poisoning)
full obs
Never induce vomiting, although you may not be able to prevent it
Ascertaining what poison has been taken together with the time and quantity
Not giving anything by mouth unless directed by information on a container
For swallowed caustics and petroleum products dilute by giving milk on scene where possible
Collecting and retaining samples of substance taken for identification
Transporting to hospital as a matter of urgency
Retaining any vomit for analysis
Taking a relative to the hospital with the patient
Placing in recovery position if unconscious
Be prepared to use suction, assist ventilations or start CPR
management of:
Neurotoxic poisons
DRABCDE
Time critical if A/B problems
O2
Assisting ventilation if req.
Be prepared for CPR
Never induce vomiting
Providing copious amounts of water or milk to dilute and delay absorption
If the poison is not known; don’t delay unnecessarily to identify it
Placing in recovery position if unconscious
Keep patient still and quiet to reduce pulse rate
Not allowing patient to walk
full obs
consider Narcan for opiate overdose
management of:
Poisonous Gases
DRABCDE Approaching the scene with care Removing the patient form poison source Ensuring an open airway Administering high concentrations of O2 Being prepared to perform CPR Loosening and removing contaminated clothing Identifying what type of gas was inhaled Informing the receiving hospital if possible Transporting to hospital
management of:
Paraquat Poisoning
DRABCDE Ensuring an open airway NOT administering oxygen, this will increase toxicity ONLY USE BVM not mouth to mouth/nose DO NOT encourage to vomit
In addition to usual clinical signs there may be evidence of burning around the mouth
management of:
Pesticide and Herbicide Poisoning
DRABCDE
Remove patient from source of poison if possible
Ensuring open airway
Assisting ventilation if required
O2
Encourage vomiting as a matter of priority if the patient has swallowed any of the substance; do not use a salt solution to do this
Removing all contaminated clothing taking care to avoid contamination yourself
Washing contaminated skin thoroughly with soap and water
Irrigating the eyes copiously with clean water and then covering with a soft pad, gauze or cotton wool secured by a bandage if contaminated
Taking to hospital for examination purposes if available:
-the container
-a sample of the substance
-any vomit for analysis
In addition to usual clinical signs there may be evidence of burning or staining around the mouth, tongue, lips
Poison management checklist
safety steps: 1,2,3 patients
Treat what you find
Consider CASMEET/blue call
Handover
PRF
Avoid contaminating yourself
Act quickly, speed is essential
Ensure open airway
Assist ventilation if necessary
Treat asphyxia first
If pt unconscious do not induce vomiting and place in recovery position
If the patient vomits spontaneously keep a sample for analysis by the hospital
Continually assess the patient for sudden deterioration
Keep the patient still and quiet, do not let them walk
Constantly re-assure the patient
Collect samples of the poison, bottles and other containers
