Poisoning & substance misuse

Question 1

Routes of entry

Answer 1

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

Question 2

History

Answer 2

Time
Drug /substance ingested - Collect all suspected drugs/substances
Quantity / cost of the drug/substance ingested
Mode of poisoning e.g. ingestion, inhalation, injection
Additional contributory / exacerbatory factors e.g. alcohol
Treatment before crew arrival
Any vomiting
Any others involved / ill

Question 3

Examination for any patient should include noting any of the following:

Answer 3

Pupil size and reaction
Pale or flushed skin
Dry or sweaty skin
Tears or rhinorrhoea
Dry or salivating mouth
Heart rate
Respiratory rate
Confusion
Seizures

Temperature
Piloerection
Delirium
Vomiting & Diarrhoea
Urinary Incontinence
Altered level of consciousness
Slurred speech
Ataxia
Amnesia

Question 4

The pancreas

Answer 4

12-15cm long
Produces and releases
1. Digestive enzymes into the duodenum via pancreatic duct (exocrine function)
2. Insulin and Glucagon directly into the blood (endocrine function)

Contains specialised endocrine cells called ‘Islets of Langerhans’ which contain 4 types of hormone secreting cells

Question 5

Islets of Langerhans

Answer 5

Alpha Cells – secrete the hormone Glucagon which raises the blood glucose levels
Beta Cells - secrete the hormone Insulin which lowers blood glucose level by allowing it to pass into the cells that need it.
Delta Cells – secrete growth hormone inhibiting cells (GHIH) or somatostatin, inhibiting secretion of Insulin and Glucagon
F – Cells – secrete pancreatic polypeptide which regulates digestive enzymes

Question 6

Glucagon

Answer 6

Glucagon is hormone produced naturally by the pancreas in response to low blood glucose levels and to high cortisol levels

Glucagon triggers the liver to convert its store of glycogen back into Glucose by a process called Glycogenolysis. The Glucose is then available to be used by cells to create energy

It also breaks down stored fat into fatty acids for use as fuel by the cells

Synthetic Glucagon is administered to patients with very low blood sugar

Question 7

Insulin

Answer 7

A naturally produced hormone

Insulin is released in response to rising blood glucose levels

Insulin is required to ‘unlock’ the cells to allow the glucose to enter and be transformed into energy.

Also converts excess glucose to glycogen for storage in the liver. This is called glycogenesis.

Question 8

Hypoglycaemia – signs and symptoms

Answer 8

Sweating
Palpitations
Shaking
Hunger
Headache
Nausea
Drowsiness
Odd / aggressive behaviour
Speech difficulties
Fitting
Confusion
Unconsciousness