emergency toxicology Flashcards
Incidence
Poisoning is the leading cause of injury related death
(US Statistics)
• Patients aged 35 to 54 years accounted for the highest
number of poisonings
• 28.3% required management at a health care facility
• 7.9 % required hospital admission
Challenges in Managing the Poisoned Patient
Limited ingestion/exposure history
• Potential for several toxins to be involved
• Agitated/Aggressive patients
• Trauma/Underlying Medical Issue
what are the hazards to the paramedic
Limited History • Hazards (example at the farm /worksite) – Exposure to toxins – Agitated patients/bystanders • Limited Diagnostics
- Scene Survey
* Scene Clues (Aid in determining substance involved)
Scene Survey – Hazards (fire) • Toxins • Upset/Agitated Patients or Bystanders • Scene Clues (Aid in determining substance involved) – Drug Paraphernalia – Pill Containers – Physical Assessment – Vomitus
Toxidromes
toxic and syndrome
- heart pressure changes (opium)
electrocardiogram
- ultrasounds (internal fuid/ blood)
iSTAT
little machine that
• Point of care testing – Blood Gas • Toxic Alcohols • ASA • Tricyclic Anti-depressants – Electrolytes • Rule out other causes of altered LOC
Opioids
Morphine • Codeine • Dilaudid • Oxycodone • Demerol • Fentanyl • Methadone • Heroine
• Stimulate opioid receptors (μ, κ, σ) in the central and
peripheral nervous system and modulate pain
sensation
• No difference between opioids in mechanism of action
• Differences are in adverse effects, onset of action and
duration of action
clinical feature of opiate toxidrome
• Clinical Features of Opiate Toxidrome – Decreased Level of Consciousness – Respiratory Depression – Pupil Constriction – Low Blood Pressure – Nausea and Vomiting
Treatment
– Protect the Patient’s Airway
– Oxygenate/Ventilate
– Ensure Adequate Blood Pressure
– Antidote
Naloxone (Narcan)
Competitive Narcotic Antagonist (antidote)
• Commonly used to reverse narcotic toxicity
• Complications;
– Agitation/Aggressiveness
– Vomiting
Stimulants
Class of Toxins that includes: – Cocaine – Caffeine – Amphetamines – Ephedrine • Cocaine – Commonly abused stimulant seen frequently in OD scenarios
what does cocoaine do
blocks the dopamine reuptake transporter
• Clinical Features of Stimulant Toxidrome
– Euphoria – Anxiety – Agitation – Restlessness – Seizures – High Blood Pressure – High Heart Rate – Cardiac Arrhythmias – Chest Pain/Heart Attack
Treatment
of a stimulant
Ensure; – Airway – Breathing – Circulation • Sedation – Benzodiazepines • Cardiac Monitoring
Cholinergic Toxidrome
from pestisides blocks ach esterase signaling
