Toxicology Treatment Protocols Flashcards
Universal Toxicological Response
TTP-01
Determine product or agent involved. If unknown, determine symptoms of those exposed.
Provide safety of responding personnel, patients and bystanders
Document findings and contact Poison Control.
Document recommendations from Poison Control.
Institute immediate life saving therapy, based on PC recommendations. Recommend dispatch of additional Tox Medic resources to Command if necessary.
Contact OMD ASAP
Advise of PC’s recommendations and Tx rendered.
Document OMD’s orders
As new information is obtained, update:
PC, OMD, receiving hospitals.
Poison Control
602-253-3334
Refer to toxicology report: •Product concentration •Types of exposure •Length of exposure •Initial S/S •Present S/S
Eye Decontamination
TTP-02
Assure scene safety.
Preform appropriate decontamination if able.
Confirm exposure/amount/duration.
Maintain airway/breathing/circulation.
IV lock/ fluids as indicated.
Begin eye decontamination immediately.
After initial 5 min of irrigation, give:
Proparacaine Eye Drops: 1-2 drops in effected eye(s).
Wait 30-60 seconds for anesthetic effect.
Consider use of Morgan Lens to facilitate decontamination.
Continue to irrigate until directed to stop by OMD.
Do not use neutralizing agents.
Transport for evaluation of corneal damage.
Contact PC (602-253-3334) and OMD for recommendations.
Methemoglobinemia:
Algorithm
TTP-03
Assure scene safety.
Preform appropriate decontamination if able.
Confirm exposure/amount/duration.
Maintain airway/breathing/circulation.
Establish IV, NS.
Administer:
Methylene Blue: 2.0mg/kg in 100cc NS, over 5-10min.
May repeat at: 1.0mg/kg if no change in 10-20min.
Note:
Do not use for known G-6-PD deficiency.
(Glucose-6-Phosphate Dehydrogenase)
Contact PC (602-253-3334) for further recommendations. Contact OMD.
Methemoglobinemia:
Signs and symptoms
TTP-03
Signs and symptoms: •Headache/Dizziness •Altered LOC •Nausea •Dyspnea •Seizures •Coma •Skin discoloration - Primarily in nail beds, lips, and ears: •"Chocolate Cyanosis" •Chocolate brown blood
Methemoglobinemia:
Causative agents
TTP-03
Causative agents: •Local Anesthetics •Analgesics •Anti-microbals •Nitrates/Nitrites •Amyl Nitrate/Butyl Nitrate •Aniline dyes •Chlorates •Nitrobenzines •Aminophenol
*May occur with the use of Amyl Nitrate for Cyanide and Sulfide poisonings.
Organophosphate/N-Methylcarbamate/Nerve Agent Exposure
TTP-04
Assure scene safety.
Preform appropriate decontamination if able.
Confirm exposure/amount/duration.
Maintain airway/breathing/circulation.
Establish IV, NS.
Administer:
Atropine Sulfate:
Adult: 2-5mg IV every 5-10min
Pedi: 0.05mg/kg every 5-10min
Repeat dosing until Atropinization: •No wheezing •No bronchorrhea •No diaphoresis •No bradycardia •No diarrhea
Consider Atropine drip for severe cases after initial boluses: (3) 8mg/20ml vials in 1000cc NS (Total 24mg in 1060cc's) To run drip, use 10 gtts tubing. Run infusion at 88gtts/min —»1mg/5min
Administer: Pralidoxime Chloride (2PAM) Reconstitute with 20cc of sterile water. Adult: 1-2G IV over 10-15min Pedi: 30-50mg/kg over 10-15min *Sudden apnea may occur in infants, usually after the second dose.
Consider 2PAM drip for severe cases after the initial dose.
Reconstitute (2) 1G 2-PAM in 100cc (2G in 140cc’s)
To run drip, use 60gtts tubing @ 70 gtt/min —»1G/hour
Administer:
Diazepam: Adult 5-10mg IV; Pedi: 0.05-0.1mg/kg
May repeat prn for convulsions/severe agitation, and combative behavior.
Organophosphate/N-Methylcarbamate/Nerve Agent Exposure:
Signs and Symptoms
TTP-04
SLUDGE Syndrome •Salivation •Lacrimation •Urination •Diaphoresis • Emesis
Fasciculations/Seizures
LOC
Dyspnea/Apnea
Organophosphate/N-Methylcarbamate/Nerve Agent Exposure:
Notes
TTP-04
Contact Poison control for further recommendations:
602-253-3334
Exposure: Vapor or absorbed
Will penetrate clothing
Mark 1 kit appropriate for mass casualty situation
Sulfide Poising
TTP-05
Assure scene safety.
Preform appropriate decontamination if able.
Confirm exposure/amount/duration.
Maintain airway/breathing/circulation.
Establish IV, NS.
Administer:
Amy Nitrite: Break pearl and hold over face of breathing Pt, or over intake valve of BVM for 30sec/min while IV is established. If already established —»Sodium Nitrite
Sodium Nitrite IV:
Adult: 300mg over 5-10 min (Can give faster during codes)
Pedi: 0.33ml/kg of 3% solution IV over 5-10min
Repeat if no response w/in 15-30 min
Contact PC for further recommendations:
Contact OMD
Sulfide Poising:
Signs and Symptoms
TTP-05
S/S Sulfide Poising: •May report "Rotten egg" odor •Upper airway irritation •Laryngospasm •Painful dermatitis •Pneumonitis •Non-Cardia Pulmonary Edema (Late onset)
Sulfide Poising:
Sources & Notes
TTP-05
Sources & Notes
•Cellular asphyxiant
•Rapid-acting airway irritant
•Rapid olfactory overload- May not report “rotten egg” odor
Sources: •Decaying organic matter •Petroleum refining •Mining •Pulp/Paper factories •Sewage •Hot asphalt fumes
*Rotten Egg odor may be present with concentrations as little as 0.025ppm
Cyanide Poisoning
TTP-06
Assure scene safety.
Preform appropriate decontamination if able.
Confirm exposure/amount/duration.
Maintain airway/breathing/circulation.
Establish IV, NS.
Administer:
Amy Nitrite: Break pearl and hold over face of breathing Pt, or over intake valve of BVM for 30sec/min while IV is established. If already established —»Sodium Nitrite
Sodium Nitrite IV:
Adult: 300mg over 5-10 min (Can give faster during codes)
Pedi: 0.33ml/kg of 3% solution IV over 5-10min
Repeat if no response w/in 15-30 min
Sodium Thiosulfate (25%):
Adult: 12.5G (50ml of 25%) IV over 5min
(Can give faster during codes)
Pedi: 1.65 ml/kg of 25% solution over 5min
Contact PC for further recommendations:
Contact OMD
Cyanide Poisoning:
Signs and symptoms
TTP-06
Signs and symptoms: •Abrupt onset of profound effects •Headache/Altered LOC •LOC •Nausea •Dyspnea-Agonal Respirations •Seizures •Cardiovascular Collapse
Cyanide Poisoning:
Sources and notes
TTP-06
Sources and notes:
•Chemical Asphyxiant
•Almond-like smell
Sources:
•Apricot pits
•Cassava
•Combustion of plastics/synthetics/wool
PC = 602-253-3334
