EMER 198 Medical 2 Flashcards
Behavioural disorder and examples
interferes with a persons ability to perform activities of daily living Mental health problem Depression Borderline, personality disorder
Behavioural emergency
exist when the abnormal behaviour threatens a persons health and safety with the health and safety of another Imminent to have harm on others
Psychiatric emergency
person becomes suicidal, homicidal, or has a psychotic episode in which a person often experiences delusions and hallucinations
DelusionsHallucinations
Delusions: false beliefs Hallucinations: false perceptions
Causes of abnormal behaviour
Diabetes, seizure disorder, severe infections, metabolic disorders, head injury, stroke, alcohol, tumours in the brain and drugs may all cause derangements in behaviour
organic brain syndrome
abnormal behaviour are actually suffering from physical illness or are under the influence of a substance that effects normal cerebral function
Toxic and deficiency states
Drug induced psychosesNutrition disorders Poisoning with bromide or other heavy metals Kidney failure Liver failure
Drug induced psychoses especially from:
Digitalis Steroids Disulfiram Amphetamines LSD, PCP and other psychedelics
Delirium
Is a symptom not a disease Temporary/reversible condition that results in rapid changes to behaviour May complicate the assessment of the underlying problem
Excited delirium
is a controversial condition that arises typically in male subjects with a history of mental illness and/or acute or chronic drug abuse, particularly stimulant drugs. Some groups claim that this condition was “invented” to cover up the use of excessive force by law enforcement the American College of Emergency Physicians has accepted excited delirium as a unique syndrome, despite the World Health Organization, and the American Psychiatric Association failing to acknowledge it as a medical or psychiatric diagnosis.
Excited delirium is characterized by a combination of the following:
• Delirium • Agitation or anxiety • Violent bizarre behaviour • Inappropriately clothed • Hallucinations or visual disturbances • Inability to feel pain • Superhuman strength • Elevated body temperature (hyperthermia) • Excessive sweating even in cold weather
Paramedics should consider the following when dealing with a patient displaying the signs of excited delirium:
• Are we safe? • Consider the need for physical restraint and sedation (ALS skill). Physical restraint is something that should be conducted with appropriate resources and preferably the assistance of law enforcement. • Is the patient safe? • Arms, legs, and body securely affixed to the cot? • If the choice to restrain is made are we restraining the patient in such a way to allow for breathing and airway control? • If ALS sedates the patient are we in a position to assist with breathing and provide supplemental oxygen? • What else could be going on? • remember that we need to rule but all other conditions before deciding on one specifically.
Psychosocial causes
Individuals may develop abnormal reactions to stressful psychosocial events or developmental influence
When exposed to stress this causes a crisis most of the time the patient will resolve the crisis in one of two ways they are:
Coping with it they will find ways to alter the situation to make it less stressful Attempt to alleviate the discomfort by escaping including drug, alcohol, psychiatric symptoms and in some cases suicide
Categories of psychiatric disorders
Cognitive Thought Mood Neurotic Substance related disorders and addictive behaviour Somatoform Factitious Impulse control Personality
Disorders of consciousness
Distractibility and inattention Confusion Delirium Stupor and coma
Disorders of motor activity
Restlessness steryotyped movement compulsionsretarted movements
Stereotyped movementsCompulsions
Stereotyped movements: involves the repetition of movements that do not seem to serve any useful purpose Compulsions: repetitive actions that are carried out to relieve the anxiety of obsessive thoughts
Neologisms
words that the patient invents
Echolalia
the patient echos the words of the examiner
Retardation of thought
it seems to take a very long time to get from one thought to the next
Circumstantial thinking
the patient includes many irrelevant details in his or her account of things
Preservation
refers to the repetition of the same idea over and over again
Delusions of persecution
the individual believes that others are plotting against him or her
Delusions of grandeur
the patient believes he or she is someone of great importance
AmnesiaConfabulation
Amnesia: the loss of memory Confabulation: patients with severe memory deficits from organic brain disease will invent experiences to fill in the gaps
IllusionHallucination
Illusion: miss interpretation of sensory stimuli Hallucination: it’s a perception that has no basis in reality and occurs without any external stimuli
Generalized anxiety disorder
When a person worries about everything for no particular reason or if the worrying is unproductive in the individual cannot decide what to do about an upcoming situation Must be present for more days than not for a period of at least six months and the worry must be difficult to turn off or control
Phobias
Focusses all his or her anxieties onto one class of objects or situations Confronted with the feared object or situation the person experiences intolerable anxiety
Panic disorder Agoraphobia
Characterized by sudden usually unexpected and overwhelming feelings of fear and dread accompanied by a variety of other symptoms Agoraphobia: the fear of going into public places : the fear of going into public places
Depression mnemonic
GASP PIPES: guilt, appetite, sleep disturbance, paying attention, interest, psychomotor abnormalitites
Manic behaviour
One of the most striking psychiatric conditions The manic patient is more likely to report being on top of the world I’ve never felt any better when they are not
Mental status examination
COASTMAP: consciousness, orientation, activity, speech, thought, memory, mood, affect and perception
The mental exam on a manic patient
Consciousness: easily distracted Orientation to place and time: disrupted Activity: hyperactive almost always report is significantly decreased need for sleep and I go for days without sleeping Speech: pressured and rapid very talkative Thought: flight of ideas and delusions patient may report of butter racing Affect: oh hallmark of mania the patient seems to be on a high and is usually cheerful Perception: may be disrupted
Somatoform disorders
People who are overly concerned with their physical health and appearance
Munchausen syndrome
intentionally getting sick for attention
Psychosis
state where patient is out of touch with reality and are focused on their version of it
schizophrenia
complex disorder that is neither easily defined nor readily treated Typical onset occurs during early adulthood May experience positive negative or disorganized symptoms
Positive symptomsNegative symptomsDisorganized symptoms
Positive symptoms: include delusions and hallucinations Negative symptoms: include apathy, mutism, a lack of interest in pleasure Disorganized symptoms: erratic speech, emotional response and motor behaviour
Paranoid schizophrenia
characterized by delusions or hallucinations usually centred on a specific theme
Disorganized schizophrenia
usually display the wrong emotion for a particular situation and have disorganize speech behaviour
Catatonic schizophrenia
Display odd motor activity such as strange expressions in their face or remaining rigid
Mental Status examination for the psychotic patient
Consciousness: awake and alert but may be easily distracted Orientation: may be disoriented as to time and place in severe cases Activity: most commonly accelerated with agitation and hyperactivity bizarre stereotyped movement are common Speech: may be pressured or sound strange because I’m an usual words that the patient has invented Thought: loosening associationsthought insertion:thought withdrawl: affect and mood: likely to be disturbed in psychosis perception: auditory hallucinations are common in psychosis
loosening associations:thought insertion: thought withdrawl:
loosening associations: the logical connection between what idea in the next becomes obscure at least a listener thought insertion: the believe that thoughts are being thrust into his or her mind by another person thought withdrawl: the believe that thoughts are being removed
Medication for psychosis
Separated into two groups Atypical antipsychotic (AAP) agents Traditional antipsychotic agents
Atypical antipsychotic (AAP) agents
Acute dystonic reaction: the patient develops muscle spasms of the neck, face and back within a few days of starting treatment with the medication
Traditional antipsychotic agents
Atropine like effects: dry mouth, blurred vision, urinary retention and cardiac dysrhythmias
Attention Deficit Disorder
neurobiological condition characterized by developmentally inappropriate level of attention, concentration, activity, distractibility, impulsivity, and in the case of ADHD, hyperactivitythe most commonly diagnosed childhood behavioural disorder with symptoms beginning by three years of age
ADHD Signs and Symptoms
Does not pay close attention to details • Makes careless mistakes at work, school, or other activities • Difficulty maintaining attention on tasks or play activities • Difficulty organizing tasks • Easily distracted • Unable to follow more than one instruction at a time • Talks excessively • Has trouble participating in “quiet” activities
Autism spectrum disorder
is a complex developmental disorder that appears in the first three years of life, but may be diagnosed much later. Autism affects the brain’s normal development of social and communication skills. Core features include impaired social interactions, impaired verbal and nonverbal communication, and restricted and repetitive patterns of behaviour.
autism Signs and Symptoms
• Unusual responses to the environment • Impaired social interaction • Repetitive movements such as rocking and twirling • Self-abusive behavior • Gross deficits in language development and speech patterns • Frequently associated findings: • Congenital blindness • Mentally impaired • Normal or even exceptional development with memory or math calculations • Grand mal seizures before adolescence
Anxiety meds overdose signs and symptoms
Severe hypoventilation Severe hypotension Bradycardia Slurred speech Altered mental status Impaired coordination
SSRIs
Side effects: headaches, dizziness, sexual dysfunction,nausea, diarrhea and insomnia
Heterocylic antidepressents
Side effects: anti cholinergic (dry) or cardiotoxic ( ecg changes and dysrhythmias)
Monoamine oxidase inhibitors (MAOIs)
Recommended for aytipical major depressive episodes Side effects: CNS irritabili
Hypothalamus
mediator between nervous system and endocrine system
Pituitary gland(base of brain)
master gland- responsible for controlling others
ThyroidParathyroid:
Thyroid: secretes thyroxine- main metabolic hormone Parathyroid: regulates calcium
Adrenal glands
cortical steroids
Medulla
epi and nor epi
Pancreas
controls beta and alpha cells
Beta cells
releases insulin
Alpha cells
release glucagon
pathophysiology of Type 1 diabetics (insulin dependant)
Cell takes glucose into cell to create energy but insulin dependent diabetics’ cells don’t let glucose in so it uses fat as energy which is converted to fatty acids The fatty acids create a lot of ketones as by products Ketones convert to hydrogen ions, CO2 and heat This can lead to diabetic ketoacidosis
Diabetic Ketoacidosis
Life threatening Occurs when certain acids accumulate in the body DKA occurs when the cells experience famine Because the cells are lacking glucose to convert to energy they begin to use other sources for energy The metabolism of fat causes the build up of acids and ketones The body also experiences a loss of water and electrolytes due to high levels of glucose in the blood
PolyuriaPolydipsiaPolyphagia
Polyuria: Compensating mechanism of too much sugar is to pee it out Polydipsia: drinking lots of water Getting dehydrated from so much peeing Up to 6L of dehydration Polyphagia: eating excessive amounts of food Cells don’t get enough sugar trying to eat more
Signs and symptoms of DKA
PolyuriaPolydipsiaPolyphagiaTachycardia: consequence of dehydration trying to get sugar Kusmals breathing: deep and fast breathing trying to blow of co2 Warm dry skin
Hyperosmolar nonketotic coma (HONK)
BGL greater than 33MMOL/L A metabolic disorder that occurs primary in type 2 diabetes ‘Characterized by hyperglycemia, hyperosmolarity and abscence of ketosis HONK and DKA tend to overlap and often observed simultaneously HONK develops secondary in patients with diabetes who have some secondary illness that leads to reduced fluid intake
Diabetes Mellitus
A metabolic disorder in which the bodys ability to metabolize simple carbohydrates (glucose) is impaired
inability to sufficiently metabolize glucose because of
1)The pancreas does not produce enough insulin 2)The cells do not respond to the effects of the insulin
Type 1
Common in children Also know as juvenile diabetes Most type 1 patients produce too little to no insulin at all –Viral response attacks Tcells and beta cells in pancreas –Autoimmune disorder These patients require daily doses of insulin to: –Regulate sugar levels –Prevent the formation of ketoacids Diabetic patients will use diet control to assist in management of their condition
Signs and symptoms type 1
Sudden weight lost- veryhungy Frequent urination Numbness tingling Blurried vission
Type 2
Most common Adult onset diabetes Insulin resistanceTypically medications, exercise and diet control are used to manage
type 2 signs and symptoms
Fatigue Nausea Frequent urination Thirst Unexplained weight loss Blurred vision Slow healing Cranky Confused Shaky Unresponsiveness Seizure
Hypoglycemia
Low blood sugar Less than 4.5mmol/l Usually the result of taking too much insulin or oral diabetic medicine, too little food or both This causes the cells and brain to be starved of glucose
Hypoglycemia signs and symptoms
Tachycardia Sweating Hunger Headache Confusion Memory loss Incoordination Dilated pupils Slurred speech Seizure/coma Severe cases may present as a stroke Cool and clammy needs some candy
Hyperglycemia signs and symptoms
High blood glucose level Most common presenting feature of diabetes mellitus Typically the result of excessive food intake, insufficient insulin dosages, infection or illness If this is left untreated may lead to DKA Caused by excessive efood intake, insufficient insulin dosages, infection or illness, injury, emotional stress Hot and dry- sugar is high
Treatment
LOC ABC skin If they are low and can eat let them eat carbs Unconscious IV D5,10,50 DKA- NEEDS FLUID!!!!!!
Seizures
Sudden erratic firing of neurons Abnormal electrical discharge from the brain Signs and symptoms depends on the part of brain Causes- we don’t really know why idiopathic
Generalized seizure
Affect large portion of the brain Includes tonic-clonic and absence types Tonic clonic: full body movement
Steps of a tonic clonic
Aura: pt experiences a sensation Loss of cx: pt loses consciousness Tonic: body wide rigidity Hypertonic: arched back and rigidity Clonic: rhythm contraction of major muscle groups Post seizure: muscles relax Postictal: “rest” period for the brain may last minutes to hours Breathing will sound abnormal
Absence Seizure
Absence spells (thousand-mile stare) Most common in children Short duration
Partial seizures
affecting a limited portion of the brain
Complex partial Simple partial (Jacksonian March)
Complex partial -Subtle loss of cx -Head or eyes make small movement Simple partial (Jacksonian March) -Tonic clonic activity to one body part -No aura or loss of cx
Febrile seizures
Caused by high body temp Neurons in the brain are highly sensitive to temperature changes As the temp rises the effects on the neurons become more profound and if allowed to progress may lead to a seizure Simple and short- if they’re long or hard to stop the seizure is probably in conjunction with an underlying problem Very short to no postictal period
Status epilepticus
A seizure that last for longer than 4-5mins OR consecutive seizures that occur without return of cx between seizure episodes True medical emergency!!
Convulsive Disorders ASSESSMENT
Stay calm Communication Questions –Where and what was the patient doing before the seizure –How long did it last What did it look like –Does the pt have a history of seizures ——Are they like this one ——Any medication changes -Pt have a fever -Was the pt apneic, cyanotic or vomiting -Incontinence? -SAMPLE -v/s
Convulsive Disorders- TREATMENT
OPA/NPA Positioning Supplemental oxygen Don’t let tubing get tangled Suction ready Rule out treatable causes Temp BGL Pupils- drugs IV- med route Cardiac monitor ALS
Sinus headache
pain is usually behind the forehead and/or cheekbones Caused by inflammation or infection of sinus cavities in the face Increase with movement Usually worse when person first wakes up Can be flu symptoms
Cluster headache
pain is in and around one eye Vascular type Often start in face Last 30-45 mins Pain radiates to entire side of face Can occur multiple times a day and then just go away
Tension headache
Pain is like a hand squeezing the head Cause from stress Tense muscles Most common
Migraine headache
pain, nausea and visual changes are typical of classic form Some patients experience aura before Pain unilateral and focused Pain will change or spread over time Throbbing, pounding or pulsing in nature Can last hours to days
cluster headache Treatment
Symptomatically Supportive and comfort
Bell’s Palsy
Temporary paralysis of 7th cranial nerve 7th cranial nerve controls facial movement Takes weeks to months to go back to normal
Bell’s Palsy Treatment
Symptomatically Supportive and comfort
Trigeminal neuralgia
The normal function of facial blood vessels produces severe pain As the blood vessel change in diameter to meet the needs of surrounding tissue their positions can irritate the trigeminal nerve This nerve is responsible for receiving signals related to pain, temperature and pressure on the face
Cerebrovascular Accidents (CVA)2 types:
Ischemic stroke: blockage -Thrombotic -Embolic Hemorrhagic: ruptured artery/vesel -Loss of blood flow to some part of the brain -Temporary or permanent damage from lack of oxygen -Signs and symptoms depends on artery and area of brain
Ischemic CVA
75% most common Caused when a blood vessel becomes occluded and blocked blood flow Only the tissue on the blockage will be affected Eventually will plateau Severity depends on part of brain
Hemorrhagic
Bleeding that has interfered with the brains ability to function 20% less common More devastating because it worsens overtime Can start to see signs and symptoms of ICP Pressure on them medulla oblagata results in Cushing’s reflex Common complaint “worst headache they’ve ever experienced”
Transient ischemic attack (min stroke)
Temporary artery blockage s/s resolve within 24hrs warning sign of a larger CVA to come present similar to CVA except s/s resolve encourage transport for further assessment
signs and symptoms of CVA/ TIA
slurred speech unilateral weakness or paralysis facial droop arm drift headaches decreased LOC seizures N/V
CVA/ TIA ASSESSMENT
LOC ABCs mental status AOX4? GCS BGL FAST VANCHECK PUPILS
CVA/ TIA Treatment
Secure airway Suction ready Positioning Constant reassessment of ABC Supplemental oxygen BGL IV try 2 large bore Avoid using the affected limb Cardiac monitoring COMMUNICATE KEEP THEM INFORMED THEY CAN STILL HEAR YOU ALS Get to hospital with abilities
Syncope
Sudden temporarily loss of consciousness and lose all postural tone Older people: dysrhythmias Younger: vagal Short in nature usually only a matter of seconds No postictal period Causes Cardiac rhythm Cardiac muscle Dehydration Hypoglycemia Vasovagal
Abscess in the brain
Occurs when and infectious agent invades the CNS Over time swelling may occur causing neural tissue damage and increased ICP Signs and symptoms gradual and subtle, signs indicating infection
AEIOU TIPS
Alcohol Epilepsy Insulin Overdose Uremia (build up of toxins from renal disease) Trauma Infection Psychiatric or poisons Stroke
altered mental status Treatment
Hallmarks of ICP Cushings reflex Bradycardia Slow resps Hypertension ABCs Rule out treatable causes Symptomatically IV Cardiac monitor ALS if needed Transport
Amyotrophic Lateral Sclerosis (ALS)
Lou Gehrig’s Disease Involves the death of voluntary motor neurons There is no effect on the patients consciousness In most cases it is fatal Progression of ALS is patient dependent
Cerebral Palsy
Is a developmental condition that causes damage to the brain, typically the frontal lobe It is a self limiting condition and doesn’t worsen over time Begins in infancy, milestones like walking, crawling and talking maybe delayed 70-80% of CP cases are “spastic” (near constant state of contraction)
Multiple Sclerosis (MS)
Autoimmune condition that attacks the myelin sheath of neurons in the brain and spinal cord MS presentation usually follows a pattern of attacks and remissions The initial attack double vision and blurred vision or common reports other symptoms include muscle weakness impairment of pain, temperature and touch, tremors, speech disturbances, vertigo, bladder or bowel dysfunction, depression, euphoria, cognitive abnormalities and fatigue
Muscular Dystrophy (MD)
A non neurological condition of genetic origin marked by degeneration of muscular tissue Many forms of MD exist May affect all types of muscles including respiratory and cardiac muscles Mostly males Diagnosed before 5 years old Life expectancy not past 20 years
Parkinson Disease
The portion of the brain that produces dopamine becomes damaged Dopamine is responsible for smooth muscle contraction and other things The classical presentation is: Tremor Postural instability Rigidity Bradykinesia- choppy movements Continues to advance and worsen
Poliomyelitis
Viral infection In children Fecal oral route Multiplies in intestine and moves to neuro system Through vaccinations this disease has been almost eradicated from the world
Poliomyelitis s/s
NV Sore throat Diarrhea Stiff neck Weakness or paralysis
Dystonia
Severe abnormal muscle spasms that caused bizarre contortions, repetitive motions or postures Involuntary and often painful Sometimes caused by medication’s
Spasmodic torticollis
is a primary dystonia in which the neck muscles contract twitching the head to one side and pulling it forward or backward the head then remains painfully frozen in that position
Bell palsy
Temporary paralysis of the facial nerve seventh cranial nerve This facial nerve controls the muscles on each side of the face transmits taste sensations from the tongue And the talk is very sudden and can easily be confused with a stroke Find and symptoms include eyelid drooping, facial droop or weakness, drooling and loss of the ability to taste Will often resolve within two weeks
The damage of these invaders (bacteria) inflict occurs due to one of the two mechanisms:
the body’s reaction to the infection the activities of the attacking organisms
endotoxinsexotoxins
endotoxins: are proteins that are released by Graham negative bacteria when they die exotoxins: are proteins that are secreted by some bacteria or fungi to aid in the death and digestion of other cells
Guillain- Barre Syndrome
Rare condition Causes is unclear Condition is frightening for patients It begins with weakness in the legs the progresses to the thorax and finally arms Onset times is rather short- some cases hours from full mobility to complete paralysis requiring ventilator support
Meningitis
Infection or inflammation of the meninges Caused either by bacteria or virus Viral more common True diagnosis comes fro CSF exam Can be contagious Signs and symptoms start with flu symptoms Tell-tale sign is stiff neck
Encephalitis
Acute inflammation or infection ofnthe brain Differs from menigitis because it effects brain tissue rather that the meninges May be cause by Meningitis Virus Bacteria Can be contagious
Neoplasm
Cancer in the brain or spinal cord Two basic types: Primary: began in nervous system Metastatic: began else where and metastasized to nervous system
Causes Neoplasm
Degenerative: results were normal structure is altered overtime Developmental: arise in portions of the nervous system are not formed correctly The earlier the errors the more severe than damage
s/s Neoplasm
headache changes of mental status (behaviour personality) n/v stroke like symptoms seizures may present like brain abscess but no signs of infection] can be rapid or gradual
nerves are responsible for airway control
The trigeminal, glossopharyngeal, Vagus and hypoglossal nerves
Coma
a state in which the patient does not respond to verbal or painful stimuli
Agnosia
patient will be unable to name common objects because connections between visual interpretation of objects in the words that name them have been damaged
Apraxia
refers to the inability to know how to use a common object
Receptive aphasia
the patient cannot understand or receive speech but is able to speak clearly This form of aphasia indicates damage to the temporal lobe
Expressive aphasia:
the patient cannot speak or expressed some selves clearly but is able to understand speech This form of aphasia indicates damage to the frontal lobe which controls the motor portion of speech
Global aphasia
this form of aphasia is a combination of expressive and receptive patient will not follow commands and cannot answer your questions but they can think clearly
Anisocoria
unequal pupils with greater than 1 mm difference- can be a sign of increased ICP
Nystagmus
The involuntary, rhythmic movement of the eyes can be caused by seizures, vertigo and MS
Hemiparesis
weakness of one side of the body
Hemiplegia
paralysis of one side of the body
Decussation
in which nerves cross as they leave the cerebral cortex move through the brain stem and arrive at the spinal cord Left cerebral stroke with therefore result in right side arm and leg weakness but left side facial droop
Ataxia:
the term used to describe changes in a persons ability to perform coordinated motions like walking
Myoclonus
is a type of involuntary contraction of the muscles that is rapid and jerky nature
Intension tremorsPostural tremors
Intension tremors: occur when the patient tries to reach out and grab an object Postural tremors: occur when a body part is required to maintain the same position for a long period of time
Paraesthesia
sensation of numbness or tingling
Anaesthesia
if the patient can feel nothing within a body part
o Carbon monoxide signs
Flu symptoms Unable to think clearly Bounding pulses Dilated pupils Pallor or cyanosis Cherry red skin is late sign and already dead
Toxidrome
- Narcotics, cholinergics, anticholinergics, sympathomimetics, stimulants and sedative hypnotics
Stimulant drugs
o Amphetamineo Methamphetamineo Cocaineo Diet aidso Nasal decongestants
Stimulant s/s
o Restlessnesso Agitationo Incessant talkingo Insomniao Anorexiao Dilated pupilso Tachycardiao Tachypneao Hypertension/hypotensiono Paranoiao Seizureso Cardiac arrest
Narcotic (opiate and opiod)- Drugs:
o Heroino Opiumo Morphineo Hydromorphine (Dilaudid)o Fentanylo Percodan
Narcotic (opiate and opiod)-Signs and symptoms
o Pin point pupilso Respiratory depressiono Needle tractso Drowsinesso Coma
Sympathomimetic- Drugs:
o Amphetamineo Methamphetamine
Sympathomimetic- Signs and symptoms
o Hypertensiono Tachycardiao Dilated pupilso Hyperthermiao Seizures
Sedative and hypnotic - Drugs:
o Phenobarbitalo Diazepam (valium)o Thiopental
Sedative and hypnotic - - Signs and symptoms
o Drowsinesso Disinhibition o Slurred speecho Confusiono Respiratory depressiono CNS depressiono Hypotension
Cholinergic - Drugs
o Diazinono Ortheneo Parathiono Sarino Tabuno VX
Cholinergic - Signs and symptoms
o Increased salivationo Lacrimationo Gastrointestinal distresso Diarrheao Respiratory depressiono Apneao Seizureso Coma
Anticholinergic - Drugs
o Atropineo Scopolamineo Antihistamineso Antipsychotics
Anticholinergic - Signs and symptoms
o Dryo Flushed skino Hyperthermiao Dilated pupilso Blurred visiono Tachycardiao Mild hallucinationso Dramatic delirium
Hydrocarbons
- Typically inhalations of hydrocarbons are intentional and “recreational”- They provide a quick inexpensive high- Began in the early 1960s- Be very cautious when entering the patients environment after huffingTreatment - Remove from area- High flow o2- Transport
Toxic alcohols
ethylene glycol and methyl alcohol
ethylene glycol
antifreeze, coolant, de-icers, polishes and paintso Lethal dose 2ml/kg
ethylene glycol 3 stages of toxicity stage 1
- CNS depression patient may appear intoxicated without the obvious odour of alcohol present • these symptoms progressed to include nausea vomiting seizures • stage one begins soon after ingestion and can last up to 12 hours
ethylene glycol 3 stages of toxicity stage 2
cardio pulmonary symptoms begin to appear as the patient enters a second stage • the patient may exhibit hypertension hypertension or tachycardia• pulmonary injury may present as pulmonary edema, pneumonitis or acute respiratory distress syndrome • stage two may develop between 12 and 24 hours
ethylene glycol 3 stages of toxicity stage 3
flank pain, haematuria often characterized the third stage • the kidneys are injured and acute renal failure may develop • stage three may develop 24 to 72 hours after ingestion
methyl alcohol
paints, paint removers, windshield washer fluid, varnishes, antifreezes and canned fuelso little as 30ml can cause deatho Symptoms begin from 12 to 18 hours after ingestion- Doses as little as 2 tablespoons may prove to be lethal
toxic alcohols signs and symptoms
- Abdominal pain- Altered LOC- Heart dysrhythmias - Tachypnea- Many others
- Alcohol withdrawl seizures
o Occur within about 12-48 hours after a persons last drinko Typically short lived and self resolving
- Delirium tremens
o Most serious and lethal complications of alcohol withdrawlo Symptoms start typically around 48-72 hours after the last drinko It happens when people stop cold turkey because the body cant adapt to the changes as fast as it is to stop drinking
Delirium tremens s/s
confusion, tremors, restlessness, hallucinations, hypotension (secondary to dehydration)
Organophosphates and carbamates
- Toxidrome: cholinergic- Include agents like sarin gas, pesticides and many household products- These agents prevent the breakdown of acetycholine. Thus over stimulating the parasympathetic nervous system- Decontamination is the first priority
Organophosphates and carbamates s/s
- Confusion- Restlessness- Tremors- Motor weakness- Seizures- watery
- DUMBELS
diaphoresis and diahrea, urination, miosis, bronchospasm bradycardia, emesis, lacrimation, salivation
cyanide
- typically used for ore extraction, fumigation of structures- was used in WWII and in US gas chambers- amyl nitrate is the antidote - very quick- smell of burnt almonds on patients breath - respirations rapid and laboured early and slow down - initially hypertension then hypotension
caustics
- strong acid ph below 2.0- strong alkalide ph above 12.0- common in industry, agriculture, and the home- ingestion may produce burns and difficulty swallowing - will present as severe burns - try and find the bottle of it look at it but don’t take it - is it on shirt, floor, did they spit it up
- barbiturate
resemble alcohol intoxicationo tolerance builds quicklyo at risk of life threatening withdrawal symptoms
- benzodiazepines
produce potent CNS depression and may interfere with a patient airway o at risk of life threatening withdrawal symptoms o commonly used to treat anxiety, seizures, and withdrawals
benzodiazepines overdose symptoms
CNS depression- LOC, confusion, slurred speech, hypotension, resp depression, bradycardia
narcotics
- common uses for narcotics include analgesia- used for pain management, recreational drug
narcotics s/s
- CNS effects- uforia, hypotension, n/v, bradycardia, seizures, pin point pupils
- opiate- opioid
- opiate= drugs derived from opium or the poppy- opioid= derived from non-opium derived synthetics
Stimulants
- Can be taken orally, smoked or injected- Enhance the release of catecholamines which stimulate the CNS - Stimulates the body- excite the body- increased heart rate, body temp, resp rate- The most life-threatening presentation of stimulant abuse includes dysrhythmias, vascular events, hypertension, hyperthermia, seizures and agitation
- Cocaine s/s
o Causes widening of the QRS in an ECG and dysrhythmiaso Hypotensiono Tachycardia followed by bradycardia
Management of stimulant abuse
- Establish airway- Provide supplemental oxygen to maintain saturation levels greater than 94%- Establish vascular access- Apply ECG monitor, pulse ox and end title- Manage hypertension with fluid- Transport
Hallucinogens
- Include drugs like LSD, PCP, ketamine, shrooms and marijuana- Produce psychedelic effects
o Selective serotonin reuptake inhibitors (SSRIs)
Huge GI upset Seizures- short in nature
Selective serotonin reuptake inhibitors (SSRIs) s/s
for tachycardia, mild hypertension and lethargy also nausea, vomiting and tremors dilated pupils agitation hypertension or hypertension
o Tricyclic antidepressants (TCAs)
More common High high doses sympathomemic effects Wide QRS Cross the blood brain barrier easily
Tricyclic antidepressants (TCAs) s/s
anticholinergic effects such as dilated pupils, dry mouth, dry skin, fever, confusion, tachycardia Wide QRS
Cardiac medications- Classified as:
o Antiarrhythmicso Beta blockerso Calcium channel blockers o Cardiac glycosides
Cardiac medications - Signs and symptoms
o Bradycardiao Hypotensiono Weaknesso Confusion
Treatment
- LOC ABC- Suction- IV o Fluid bolus if indicated o Stick with 250 and reassess- Poison center - Antidote if you have it- Notify hospital of it - Cardiac monitor- Many set of vitals- Rapid transport
- Habituation
psychological and or physical dependence on a drug
- Potenation
enhancement of the effect of one drug by another drug
- Synergism
the action of two substances in which the total effects are greater than the sum of the independent affects of the two substances ex 2 + 2= 5
- Ask the following in overdoses
o What is the agent o When was the poison ingested, injected, absorbed or inhaledo How much was takeno Has the pt vomited or aspirated o Why was the substance taken
