MOD F TECH 46 Poisoning and Substance misuse Flashcards
Definition of a Poison
•A poison (toxin) is any substance which, when taken into the body in sufficient quantity, may cause temporary or permanent damage either endangering life or seriously impairing body functions.
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•Once in the body poisons attack vital organs, such as the brain, heart, lungs, liver and kidneys. Different poisons attack different organs and produce varying signs and symptoms – they may develop quickly or over a number of days.
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•Although a patient may well recover, permanent damage may occur to internal organs.
Types of Poisons
Poisons are Classified as:
Corrosive / Irritants
Non - Corrosive
Overdose and poisoning is a common complaint we are called to in the Ambulance Service and accounts for 140,000 hospital admissions per year.
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Poisons are usually taken in one of following ways:
Accidentally or Intentionally (self-harm), mal-intent
or non-accidentally.
A number of factors will affect severity and
outcome including age, toxicity of the agent,
quantity and route of exposure
How Poisons enter the Body
Inhalation – fumes, gases, solvents, vapours
Ingestion – liquids, or solids by mouth
Injection – needles, animal and insect bites
Absorption – pesticides or herbicides through the skin and eyes
JRCALC Principles of treatment
•Identify poisons / agent – household product, pharmaceutical / recreational substance, plant / fungi, alcohol, chemicals (CBRNe) or even cosmetics?
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•Specific treatment for the type of poison
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•Rapid access to hospital
Duty of Care
- It is not uncommon to find a patient who has or claims to have taken an overdose and subsequently refuses treatment or admission to hospital.
- If this happens then ensure that their mental health, capacity and suicide risk have all been assessed.
- If despite reasonable persuasion the patient still refuses treatment then it is not acceptable to leave them in a potentially dangerous situation without any access to care – do the police need to attend and / or a local mental health team?
History
- The event e.g.: when did it happen
- Drug /substance ingested
- Quantity of the drug/substance ingested
- Collect all suspected drugs/substances
- Mode of poisoning e.g. ingestion, inhalation
- Additional contributory factors – alcohol
- Has any treatment occurred yet?
Corrosive / Irritant Substances
Clinical Signs:
üLips mouth show signs of corrosion
üBurning / staining
üSevere pain / swelling mouth and throat
üWretching / vomiting
üAbdominal cramps / diarrhoea
üDifficult speech due to swelling of the mucosa
üOdours on breath
Management of Corrosive / Irritant Substances
üEnsure open airway
üO2 therapy (Paraquat with caution – only in hypoxic pt’s with SpO2 <88% aiming for target saturation
of 88-92%)
üPulse
üNever induce vomiting
üAscertain poison taken / time / quantity
Nil by mouth unless directed to by container
/ petroleum dilute = MILK
Retain samples for = Identification
Transport to hospital = Urgently
Retain vomit for = Analysis
Taking a relative to hospital with the patient if possible
unconscious Patient:
Ensure open airway
Administer oxygen
Assist ventilation if necessary
CPR = Bag / Mask Mechanical resuscitator
Avoiding Contamination
B.M.
Transport in Recovery position
Non – Corrosive Substances
Neurotoxic poisons
Generally affects the nervous system by depressing vital functions; more common ones are:
q
qMorphine
q Heroin
Barbiturates
Clinical Signs
qPinpoint pupils (with opiates
q Slow and shallow breathing
(depressed respiration)
q Lethargy and reduction in activity
q Vomiting and diarrhoea
q Loss of consciousness
Management of Neurotoxic Poisons
qEnsuring open airway
q Oxygen therapy in high concentrations
q Assist ventilation if necessary
q CPR if required
q Do not induce vomiting
q Copious amounts of water / milk to dilute and delay absorption
qPlace in recovery position
and do not induce vomiting, if the
patients unconscious
q Keep patient still and quiet
to reduce pulse rate
q Do not allow the patient to walk
Poisonous Gases
•Because of the variety of poisons which can be inhaled and their differing effects on the body, there are few clear cut signs and symptoms
Management of
Poisonous Gases
Approach the scene with care
Remove the patient from the poison source
Ensure open airway
Administer high concentrations of oxygen
CPR if required
Loosen and remove contaminated clothing
Identify what type of gas was inhaled
Inform the receiving hospital if possible (pre-alert)
Transport to hospital
Paraquat Poisoning Cases
Management of
Paraquat Poisoning
•In addition to the usual clinical signs, there may be evidence of burning around the mouth.
Open airway
O2 therapy only when hypoxaemic to maintain SAO2 @88-92%
Artificial ventilation only by bag valve mask.
Do not encourage the patient to vomit
Pesticide and
Herbicide Poisoning
- In addition to the usual clinical signs there may be evidence of burning staining around the mouth, tongue and lips
- Remove the patient from the source
- Ensure open airway
- Assisted ventilation Bag Mask / Ventilator providing O2
- Remove contaminated clothing taking care not to contaminate yourself
qWash contaminated skin thoroughly
q If eyes contaminated irrigate with copious amounts of clean water, covering both with soft pad
q Take to hospital for examination (eye causality)
q Take with you, container / sample of the substance / vomit for analysis
National Poisons Information Service
•NPIS is a service commissioned by the Health Protection Agency that provides expert advice on all aspects of acute and chronic poisoning
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•It promotes, supports and develops best practice for the management of cases of poisoning in NHS facilities
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•However it does not answer queries from the public but supports NHS Direct (0845 4647) and NHS24 (08454 24 24 24)
