Poisoning and Overdose Flashcards
poison defintion
anything can be a poison - just depends on dose
routes of entry
ingestion, inhaled, absorbed or injected
name one of the four ways a poison gets into the body
ingestion, inhaled, absorbed or injected
What questions do you ask with poison or overdose
What was involved
When
How much
over how long a period of time
what has been done to try and eliminate it
what is the patients weight
what effects have they experienced so far
fastet route for a poison
inhaled or injected
activated charcoal
Actions
- activated charcoal adsorbs (binds) certain poisons and prevents them form bend absorbed into the body
- Not all brands of activated charcoal are the same. dome adsorb more than others so consult medical direction.
certain people we don’t give charcoal to
….acid petroleum products
the solution to pollution is dilution
altered mental status
inability to swallow
dosage for charcoal
pedi 12.5 to 25 g
adult 25 to 50 g
number 1 abused substance in the world
alcohol
Delerium Tremens
2-3 days after they try to stop drinking
a severe retain that can be part of a alcohol withdrawal, characterized by seating, trembling, anxiety, and hallucinations. Severe alcohol withdrawal with the t’s can lead to death if untreated.
Symptoms confusion & restlessness unusual behavior, to the point of "insane" behavior hallucinations Gross Tremor profuse sweating seizures hypertension tachycardia
Determine if a pt is on an upper or a downer
Uppers
- display excitement
- increased pulse rate
- rapid speech
- dry mouth
- dilated pupils
- sweating
- haven’t slept in a long time
- want to see the world
Downers
- sluggish,
- sleepy
- lack coordination
- pulse and breathing rates low
- pupils dilated
Narcotics
- reduced pulse rate
- reduced depth of breathing
- lowering skin temp
- pupils constricted
- muscles relaxed
- profuse sweating
- sleepy & don’t wish to do anything
- coma in overdose
- respiratory or cardiac arrest may develop
Hallucinogens
- fast pulse rate
- dilated pupils
- flushed face
- see’s or hear’s things
- often makes no sense to the listener
Volatile Chemicals
- dazed
- temporary loss of contact with reality
- may develop coma
- numb or tingling feel inside the head
- can have changes in heart rhythm
Patient on uppers: cocaine amphet
may be snorted smoked or injected
see the world want to talk
large pupils
have to ask the question - have they taken anything
rapid heart rate - they are scared
downers
narcotics - oxycodone, hydromorphone, heroin codine morphine, dilautin, phentynyl
pipoint pupils
decrease heart rate
turn the lights down these lights are bright
overdosed on heroin
Poison
• A poison is any substance that can harm
the body
• The harm it can cause can result in a
medical emergency
• “All things are poison and nothing is without poison, only the dose permits something not to be poisonous.” Paracelsus
Common Poisons
- Medications
- Petroleum products
- Cosmetics
- Pesticides
- Plants
- Food
Effects of a Poison
• Harm to body based on nature of poison,
concentration, route of entry, patient’s age
and health
• Damage to skin and tissues from contact
• Suffocation
• Localized or systemic damage to body
systems
Classification of Poisons (By Routes of Entry)
- Ingested
- Inhaled
- Absorbed
- Injected
Ingested Poison
• Child: may accidentally eat or drink a toxic
substance
• Adult: often an accidental or deliberate
medication overdose
Assessment: Ingested Poisons
• What substance was involved?
– Look for container; check labels
– Transport with patient to hospital
• When did exposure occur?
– Quick-acting poison requires faster treatment
– ER personnel need to know for appropriate
testing and treatment
Assessment: Ingested Poisons
• How much was ingested?
– Estimate missing pills by looking at
prescription label
• Over how long a time?
– Treatments may vary
• Was medication taken for very first time?
• Was medication being taken chronically?
Assessment: Ingested Poisons
• What interventions have been taken? – Treatments indicated on label, – Other home remedies (syrup of ipecac) • What is patient’s weight? – Rate of onset of toxic effects is related to weight
Assessment: Ingested Poisons
• What effects has patient experienced?
– Nausea, vomiting, altered mental status,
abdominal pain, diarrhea, chemical burns
around mouth, unusual breath odors
Food Poisoning
• Can be caused by improperly handled or prepared food • Symptoms: nausea, vomiting, abdominal cramps, diarrhea, fever • May occur within hours of ingestion, or a day or two later
Treatment: Food Poisoning
- Activated Charcoal
* Antidotes
Activated Charcoal
• Works through adsorption, allowing
substances to attach to its surface
• Not an antidote: prevents or reduces
amount of poison absorbed by body
Think About It Poison
• Think about your own home. Is it safe for a
small child?
• Are there potential poisons within three
feet of the floor, or behind unlocked
doors?
• Are there household cleaners that look like
juices and drinks familiar to children
• Can flavored children’s medications be
mistaken for candy?
• What sense does a small child typically
use to identify things?
Public Education - Poisoning and Overdose
• Many EMS agencies are involved in educating the public to the dangers of child poisoning • Child-proofing homes • Mr. Yuk
Inhaled Poisons
• Common types – Carbon monoxide – Ammonia – Chlorine – Agricultural chemicals and pesticides – Carbon dioxide
Scene Safety -Poisoning and Overdose
- Approach scene with caution
- Protective clothing and self-contained breathing apparatus may be required
- If not trained or equipped, call for additional resources
Signs and Symptoms: Inhaled Poisons
- Difficulty breathing
- Chest pain
- Coughing
- Hoarseness
- Headache, confusion, altered mental status
- Seizures
Assessment: Inhaled Poisons
- What substance is involved (exact name)?
- When did exposure occur?
- Over how long did exposure occur?
- What interventions has anyone taken?
- Remove patient?
- Ventilate area?
- What effects is patient experiencing?
Treatment: Inhaled Poisons
• Move patient from unsafe environment using trained and equipped personnel • Open airway; provide high flow oxygen • History, physical exam, vital signs • Transport with all containers, bottles, and labels • Ongoing assessment en route
Carbon Monoxide (CO) Poisoning
• Colorless, odorless, tasteless gas created
by combustion
• Can be caused by improper venting of
fireplaces, portable heaters, generators
• Common cause of death during winter and
power outages
Signs and Symptoms: CO Poisoning
- Headache (band around head)
- Dizziness/nausea
- Breathing difficulty
- Cyanosis
- May be multiple patients with similar symptoms in confined area together
CO Monitor
• Some fire/EMS systems have monitoring devices that allow crews to determine CO exposure levels in the field
CO Detectors
• Public education programs should
encourage people to have both smoke
and CO detectors in their homes to reduce
the risk of injury and death
Treatment: CO Poisoning
• High flow oxygen is appropriate treatment,
but CO bonds to red blood cells much
more strongly than oxygen does
• Can take several hours or days to “wash”
CO from bloodstream
Smoke Inhalation
• Smoke from burning materials can contain
poisonous and toxic substances, including
CO, ammonia, chlorine, cyanide
• Substances can irritate skin and eyes,
damage lungs, and progress to respiratory
or cardiac arrest
Signs and Symptoms: Smoke Inhalation
- Difficulty breathing
- Coughing
- “Smoky” or chemical smell on breath
- Black (carbon) residue in mouth, nose or sputum
- Singed nasal or facial hair
Treatment: Smoke Inhalation
• Move patient to safe area
• Maintain airway; provide high flow oxygen
• Monitor patient closely—airway burns may
lead to swelling of airway
“Detergent Suicides”
- Method of suicide started in Japan and becoming more common in the U.S.
- Mix two easily-obtained chemicals to release hydrogen sulfide gas
- Commonly released inside enclosed space such as a car
- Exposure to fumes may injure EMS personnel
- Warning note may be left on vehicle, but this is not assured
- May need to treat first as a hazmat scene
Absorbed Poisons
- Can be absorbed through skin
- May or may not cause damage to skin
- Patient may require decontamination prior to treatment
Treatment: Absorbed Poisons
- Assess for immediate life threats
- History, physical exam, vital signs
- Brush off powder, then irrigate
- Irrigate skin and eyes for at least 20 minutes and during transport
- Transport with all containers
- Ongoing assessment en route
Poison Control Centers
Excellent resource
• Information on poisons, signs and symptoms, and treatments
• Follow local protocol for contact procedures
Alcohol and Substance Abuse
• See many patients whose conditions are caused either directly or indirectly by alcohol or substance abuse • Abuse of alcohol and other drugs crosses all geographic and economic boundaries
Alcohol Abuse
• Potent drug affects central nervous system
• Can be addictive
• Emergencies may result from recent
consumption or years of abuse
• Treat patients as any others
• Abuse can lead to or worsen other medical
conditions
Alcohol Abuse
• Alcohol often consumed with other drugs,
which can result in a serious medical
emergency
• Impaired patients can be uncooperative or
combative
• Contact law enforcement if safety concern
Assessment: Alcohol Abuse
- Many medical conditions mimic alcohol intoxication
- Intoxicated patients may also have medical problems
- All patients receive full assessment regardless of suspicion of intoxication
Signs and Symptoms: Alcohol Abuse
- Alcohol odor on breath
- Unsteady on feet
- Slurred, rambling speech
- Flushed, complaining of being warm
- Nausea/vomiting
- Poor coordination
- Blurred vision
- Confusion/altered mental status
Alcohol Withdrawal
• Abrupt cessation of drinking may cause some alcoholics to suffer from delirium tremens (DTs) • Can be serious, resulting in tremors, hallucinations, and seizures
Signs and Symptoms: Alcohol Withdrawal
- Confusion and restlessness
- Unusual behavior, demonstrating “insane” behavior
- Hallucinations, gross tremor of hands, profuse sweating
- Seizures
Patient Care: Alcohol Abuse
- Vomiting common; standard precautions are essential
- Keep suction ready
- Stay alert for airway and respiratory problems
- Monitor vital signs
- Gather history from patient, bystanders
- Stay alert for seizures
Substance Abuse
• Any chemical substance taken for other
than therapeutic (medical) reasons
• Includes illicit drugs, prescription medications, industrial chemicals
Uppers
- Stimulants that affect the nervous system
- Cocaine
- Amphetamines
- May be snorted, smoked, or injected
Stimulants such as amphetamines that affect the central nervous system to excite the user.
Downers
- Central nervous system depressants
- Barbiturates
- Rohypnol (Roofies)
- GHB
depressants, such as barbiturates, that depress the CNS, which are often used to bring on a more relaxed state..
Narcotics
• Used to relieve pain or help with sleep
• Opiates
– Heroin, codeine, morphine
• Oxycodone
Opiate Triad: Overdose characterized by coma, pinpoint pupils, respiratory depression (slow shallow reps).
a class of drugs that affect the nervous system and change many normal body activities. Their legal use if for the relief of pain. Illicit use is to produce an intense state of relaxation and a feeling of well being.
Hallucinogens
mind affecting or mind altering drugs that act on the CNS to produce excitement and distortion of perceptions.
• Create intense state of excitement and
distorted perception
• LSD, PCP, XTC
Volatile Chemicals
vaporizing compounds, such as cleaning fluid,that are berthed in by the abuser to produce a “high”
- Produce vapors that are inhaled
- Initial “rush,” then can act as central nervous system depressant
Assessment: Substance Abuse
• May be difficult
– Patient’s level of consciousness
– Patient may have taken more than one type of drug
• Patient may be uncooperative or combative
• Be aware of a possibility of contaminated needles and the presence of chemicals
Signs and Symptoms: Downers
- Sluggishness, poor coordination
* Decreased pulse and respirations
Signs and Symptoms: Uppers
- Excitement, restlessness
- Increased pulse and respirations
- Sweating
- Hyperthermia
- No sleep for a long time, possibly days
Signs and Symptoms: Narcotics
- Lethargy (patient very sleepy)
- Pinpoint pupils
- Cool skin
- Respiratory depression
- Coma
Signs and Symptoms: Hallucinogens
- Rapid pulse
- Dilated pupils
- Flushed face
- Seeing or hearing things
Signs and Symptoms: Volatile Chemicals
- Dazed/disoriented
- Swollen membranes in nose or mouth
- Numbness or tingling sensation inside head
- Changes in heart rhythm
- May be residue of chemical on face or in bag
Treatment: Substance Abuse
- Be aware of possible airway problems and respiratory distress
- Provide oxygen and assist respirations as needed
- Treat for shock
- Talk to patient to keep them calm and cooperative
- Perform physical exam
- Look for evidence of injection sites (“track marks”
- Transport as soon as possible
- Consult with medical control on further treatment
- Follow local protocol concerning consideration for restraint
Chapter Review - Poisoning and Overdose
• Perform primary assessment and immediately treat life-threatening problems. Ensure an open airway. Administer high-concentration oxygen if
the poison was inhaled or injected.
Chapter Review - Poisoning and Overdose
• Perform a history and physical exam, including baseline vital signs. Find out if the poison was ingested, inhaled, absorbed, or injected; what substance was involved; how much poison was taken in, when, and over how long a period; what
interventions others have already done; and what effects the patient experienced.
Chapter Review - Poisoning and Overdose
• Consult medical direction. As directed,
administer activated charcoal, water, or milk for ingested poisons.
• Remove patient who has inhaled poison
from the environment and administer high concentration oxygen; remove poisons from skin by brushing off or diluting.
Chapter Review - Poisoning and Overdose
• Transport patient with all containers, bottles, and labels from substance.
• Reassess patient en route.
• Carefully document all information about
poisoning, interventions, and patient’s responses.
Remember - Poisoning and Overdose
- Safety is always the first concern when dealing with a poisoning or substance abuse patient.
- Poisonings are generally classified by route of exposure. Effects vary greatly, depending upon type of poison and method of entrance into body.
Remember - Poisoning and Overdose
- EMTs must use thorough assessment, including scene clues, to help identify the nature and severity of poisoning.
- Poison control centers offer a wealth of resources to assist in assessment and treatment of poisoning patient.
Remember - Poisoning and Overdose
- Alcohol is a common underlying issue with patients. In some patients it may be the most significant problem.
- The effects of substance abuse can vary greatly, based on the type of substance. Determining the type of drug ingested can shed light on effects to come.
Questions to Consider - Poisoning and Overdose
• What are potential risks to the responder
on a poisoning or overdose call?
• What are the routes of entry into the
body?
• What are some things EMS can do to
prevent poisonings, especially in children?
Critical Thinking - Poisoning and Overdose
• A farmer calls 911 because one of his
farm hands has tried to clean up spilled
pesticide powder with his hands. On
arrival, you find that the patient insists he
has brushed all the powder off, feels fine,
and doesn’t need to go to the hospital.
Critical Thinking -Poisoning and Overdose
• As he talks, he continues to make brushing motions at his jeans on which you can see the marks of a powdery residue. How do you manage the situation?
Emergency Care Poisoning and Overdose
- Perform a primary assessment - BLS as needed
- Be alert for airways problems
- Treat for Shock
- Talk to pt & gain his confidence
- Perform physical exam to assess for injury - assess carefully for head injury
- look for gross tissue damage on extremities (tracks)
- protect the pt from self injury
- transport ASAP
- contact medical directions according to protocol
- perform reassessment
dilution
thinning down or weakening by mixing with something else. Ingested poisons are sometimes diluted by drinking water or milk
antidote
a substance that will neutralize the poison or its effects
