Poisoning Presentation Flashcards
What are the properties of CO?
- gas
- colorless
- odorless
- tasteless
- slightly higher than air
What are common sources of CO poisoning?
- endogenous
- incomplete combustion of fossil fuels and carbon containing compounds
- exposure to methylene chloride
- some drug therapy
How is CO metabolized and eliminated?
- eliminated primarily unchanged by the lungs
What percent saturation of CO causes coma and death?
over 50%
What are s/s that will be experienced by patients when their CO % saturation goes over 10%?
- slight headache
- throbbing temples
- severe headache, weakness, dizziness, n/v, collapse
What groups of people are the most susceptible to CO poisoning?
- infants
- those with lung disease
- those with CVD
- elderly
- those with anemia
What is the treatment of CO poisoning?
- remove person from source of CO
- hyperbaric O2
What about putrefaction will interfere with the interpretation of CO in the blood?
- putrefactive by products with interfere with the CO because they have the same UV spectra
- this can be an issue with fire victims as well
What are the forms that cyanide comes in?
- hydrogen cyanide (HCN) (colourless gas or blue-white liquid)
- cyanide salts eg: KCN, NaCK (white crystalline powder)
What chemical smells like burnt almonds?
- CYANIDE
What are the sources of cyanide?
- normal metabolism
- cigarette smoking
- fumigants, insecticides
- electroplating industry
- dyeing, printing, photography
- combustion of N containing compounds
- cyanogenic glycosides
What are N containing compounds?
- plastics, polyurethane bedding, carpets, insulin, etc
Cyanide attacks the ______ system
cytochrome
What does attack on the cytochrome system lead to?
- preventing oxygen utilization at the cellular level (cytotoxic anoxia)
- results in metabolic asphyxiation
What are the s/s associated with acute toxicity of cyanide?
- giddiness
- stiff lower jaw
- rapid, slow, irregular breathing
- muscle twitching
- palpitations
- cyanosis
- convulsions
- coma
- death due to respiratory arrest
What organs are most sensitive to CNS toxicity?
- brain and heart
What s/s are associated with chronic toxicity of cyanide?
- dizziness
- weakness
- congestion of lungs
- conjunctivitis
- loss of appetite
- weight loss
- mental deterioration
When does death usually occur with cyanide?
- death may be delayed for as long as 1 hour
What is the tx of cyanide poisoning?
- body can detoxify CN on its own
- CN -> SCN- (via rhodanese enzyme)
- but an inefficient system; can be speeded up by adding an exogenous source of sulfur
- 3 agents used: amyl nitrate, sodium nitrite, sodium thiosulfate
What is the most beneficial treatment for cyanide poisoning?
-sodium thiosulfate is the most beneficial tx - non-toxic, water soluble, economical to give- only limitation is that it has a longer DOA by a little bit
What fluid is cyanide best detected in?
- analytical whole blood
Enzymes in the blood will produce ____ when someone dies
CN
What can you add to blood to stop CN from being produced?
can produce NaCl
What are inhalants
breathable chemical vapours that produce psychoactive effects
What is included in the category of inhalants
volatile solvents
aerosols
anaesthetics
volatile nitrates
What is the most common volatile solvent?
toluene
What are the most common sources of volatile solvents?
- paint
- paint thinner
- household cement and glue
- lacquer thinner
- lighter fluid
- gasoline
etc
What are some of the chemicals that are involved in anaesthetic?
- NO, ether, chloroform, halothane
What are the most common sources of volatile nitrites?
- room odorizers
- tape head cleaner
- used medically to dilate blood vessels
What is “sniffing”
- directly inhaling from container or heated pan or from piece of clothing soaked in a solvent
What is “huffing”
- holding solvent soaked rag over face and breathing in through mouth
What is “bagging”
- spraying or pouring the solvent into a plastic bag holding over mouth and nose and inhaling from the bag
What is the typical inhalant user?
- young men
- low socioeconomic status
- poor student with high rate of absenteeism
What is the stimulant phase of sniffing?
- euphoria
- excitement
- release of inhibitions
- floating sensations
- delusions of gradeur
How long does the stimulant phase of sniffing last?
15-30 minutes (up to 1 hour)
What is the depressant phase?
- drowsiness
- slowed reflexes
- stupor
- bizarre thoughts
- visual/auditory hallucinations
- inebriation similar to alcohol intoxication
How long does the depressant phase last?
- lasts up to 1-2 hours after cessation of sniffing
What are the general indicators of inhalant use?
- pungent chemical door on breath or clothing
- excessive nasal secretions
- red, watery eyes, dilated pupils, rapid involuntary eye movements
- complaints of double vision, ringing in the ears, vivid dreams, hallucinations
- slow, slurred speech
- overall intoxication
- drooling, mouth sores
How fast are inhalants absorbed?
- immediately absorbed directly from lungs
Inhalants are then rapidly distributed to what organs?
- to the brain and liver
What are the long term effects of sniffing?
- fatigue
- chronic headache
- dizziness, depression
- irritability
- loss of concentration and memory
- loss of appetite
- tremor
Does sniffing cause psychological and physiological dependence?
- psych: YES
- phys: NO - but sometimes some tremors, irritability when they stop
What is sudden sniffing death?
aka sudden cardiac death
- typically follows strenuous exercise or undue stress after several deep inhalations or sniff
- caused by heart failure resulting from irregular heartbeat
- associated with halogenated hydrocarbons
