Download Poisoning and OD PPT

Poisoning

Temple College EMS Professions

Poisons 

Substance which when introduced into body in relatively small amounts causes in structural damage or functional disturbances

Suspect with: 

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GI signs/symptoms (nausea, vomiting, diarrhea, pain) Altered LOC, seizures, unusual behavior Pupil changes, salivation, sweating, other signs/symptoms of disturbed autonomic nervous system function Respiratory depression Burns, blisters of lips, mucous membranes Unusual breath odors

Treat Patient, Not Poison 

Proper support of ABCs is first step in management

Try to determine: What?  How much?  How long ago?  What has already been done?  Psychiatric history?  Underlying illness? 

When in doubt. . . Assume containers were full  Entire contents were ingested 

If several patients involved. . . 

Assume each ingested entire container contents

Always. . . Bring sample of material if possible  Save for analysis, if patient vomits  Call poison center for advice on management 

Poisoning Management 

Based on route of entry – Ingested – Absorbed – Inhaled – Injected

Ingested Poisons 

Prevent absorption of toxin from GI tract into bloodstream – Activated charcoal – Syrup of Ipecac

Activated Charcoal

Adsorbs toxin, prevents absorption from GI tract

Activated Charcoal 

Names – SuperChar – InstaChar – Actidose – Liqui-Char

Activated Charcoal 

Form – Premixed in water (slurry) – Usually bottle containing 12.5 gms

Activated Charcoal 

Dosage – 1 gm/kg of patient body weight – Usual adult dose: 25 to 50 gms – Usual child dose: 12.5 to 25 gms

Activated Charcoal 

Contraindications – Altered mental status – Inability to swallow – Ingestion of acids or alkalis

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Does not bind – Alcohol – Petroleum products – Metals (iron)

Activated Charcoal 

Side Effects – Nausea, vomiting – Black stools

Activated Charcoal 

Administration – Shake container thoroughly – Use covered opaque container – Have patient drink through straw – If patient vomits dose may be repeated

Syrup of Ipecac Induces vomiting by irritating stomach and stimulating vomiting center in brainstem  Seldom used anymore  May be helpful if ingestion has occurred within last 30 minutes 

Syrup of Ipecac 

Dose Children = 15 cc orally Adults = 30 cc orally

Repeat once after 20 minutes as needed  Be sure patient has H20 in stomach  Should not be given at same time as activated charcoal 

Syrup of Ipecac 

Contraindications – Decreased level of consciousness – Seizing or has seized – Caustic poison (acids or alkalis) – Petroleum based products

Absorbed Poisons 

Dry chemicals – dust skin, then – wash

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Liquid chemicals – wash with large amounts of H20 – avoid “neutralizing” agents

CAUTION Don’t accidentally expose yourself!

Inhaled Poisons Remove patient from exposure  Maximize oxygenation, ventilation 

CAUTION Don’t accidentally expose yourself!

Injected Poisons 

Attempt to slow absorption Venous constricting bands Dependent position Splinting of injected body part Cold packs (+) [May worsen local injury by concentrating poison]

Drug Abuse/Overdose

Substance Abuse 

Self administration of a substance in a manner not in accord with approved medical or social practices

Substance Abuse Psychological dependence  Physical dependence  Compulsive drug use  Tolerance  Addiction 

Psychological Dependence Habituation  Substance needed to support user’s sense of well-being 

Physical Dependence 

Substance must be present in body to avoid physical symptoms (withdrawal)

Compulsive Drug Use 

Use of drug and rituals/culture associated with its use become an overwhelming desire

Tolerance Increasing amounts of drug needed to produce same effects  Tolerance contributes to addiction by keeping user “chasing the last high” 

Addiction Combination of psychological dependence, physical dependence, compulsive use, and tolerance  Patient becomes totally consumed with obtaining, using drug to exclusion of all other things 

Ethyl Alcohol (EtOH)

Ethyl Alcohol A CNS Depressant Drug Decreased Reaction Time

Increased Accidental Trauma Risk

Decreased Social Inhibitions

Increased Intentional Trauma Risk

Potentiation of Other CNS Depressants

Lethal Overdoses in Combination with Other Drugs Irritation, Gastritis, Ulcer Disease, GI Bleeds Respiratory Depression, Shock

Slowed GI Tract Activity Toxic Overdose

Ethanol Intoxication Signs   

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Breath odor Swaying, unsteadiness Slurred speech Nausea, vomiting Flushed face Drowsiness Violent, erratic behavior

Ethanol Clouds signs, symptoms  Complicates assessment  Head trauma, diabetes, drug toxicity, CNS infection can mimic EtOH intoxication and vice versa 

Patient is NEVER “just drunk” until all other possibilities are excluded

Alcohol Addicts 

Experience alcohol withdrawal syndrome if they reduce intake: Restlessness, tremulousness Hallucinations Seizures Delirium tremens--all of above plus tachycardia, nausea, vomiting, hypertension, elevated body temperature

Delirium Tremens Life threatening condition!  Occurs 1 days to 2 weeks after intake is decreased  5 to 15% mortality  Control airway, prevent aspiration, monitor for hypovolemia 

Narcotics Opium  Opium derivatives  Synthetic compounds that produce opium-like effects 

Narcotics Opium  Heroin  Morphine  Demerol  Dilaudid 

Percodan Codeine Darvon Talwin

Narcotics 

Medical Uses – analgesics – anti-diarrheal agents – cough suppressants

Narcotics 

Overdose Coma Respiratory depression Constricted (pin-point) pupils

Narcotics 

Withdrawal – Agitation – Anxiety – Abdominal pain – Dilated pupils

–Sweating –Chills –Joint pains –Goose flesh

Resembles severe influenza Not a life-threat

Barbiturates Nembutal  Seconal  Pentobarbital  Amytal  Tuinal  Phenobarbital 

Barbiturates Induce sleepiness, state similar to EtOH intoxication  Medical uses 

– Anesthetics – Sedative – Hypnotics

Barbiturates 

Overdose – Coma – Respiratory depression – Shock

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Extremely dangerous in combination with EtOH

Barbiturates 

Withdrawal – Resembles EtOH withdrawal (DTs) – Extremely dangerous

Barbiturate-like Non-barbiturates Doriden, Placidyl, Quaalude, Methyprylon  Effects similar to barbiturates  Overdose can cause sudden, very prolonged respiratory arrest  Withdrawal resembles ETOH; extremely dangerous 

Tranquilizers Valium, Librium, Miltown, Equanil, Tranxene  Low doses relieve anxiety, produce muscle relaxation  High doses produce barbiturate-like effects 

Tranquilizers 

Overdose: Unlikely to cause respiratory arrest alone Extremely dangerous with EtOH

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Withdrawal – Resembles EtOH withdrawal – Extremely dangerous

CNS Stimulants: Amphetamines Dexedrine, Benzedrine, Methyl amphetamine  Relieve fatigue, promote euphoria, reduce appetite 

CNS Stimulants: Amphetamines 

Overdose – – – –

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Restlessness, paranoia Tachycardia Hypertension CVA, Heart failure Hyperthermia Heat stroke

Withdrawal – Lethargy – Depression

CNS Stimulants: Cocaine Stronger stimulant effects than amphetamines  Can cause respiratory/cardiovascular failure, heat stroke, lethal arrhythmias 

CNS Stimulants: Cocaine “Snorting” can destroy nasal septum, cause massive nosebleed  Withdrawal: 

– lethargy – depression

Hallucinogens LSD, psilocybin, peyote, mescaline, DMT, MDMA  Enhance perception  Wrong setting may induce “bad trips” with extreme anxiety  True toxic overdose rare 

Phencyclidine PCP, angel dust  Produces bizarre, violent behavior  Reduces pain sensation  Patients may be capable of feats of extreme strength  Keep patient in quiet environment, minimize stimulatin 

Solvents Glue, paint, gas, light fluid, toluene  Inhalation produces state similar to EtOH intoxication  Patient may asphyxiate if consciousness lost while “sniffing” 

Solvents Increase risk of arrhythmias  May cause liver damage, bone marrow depression  Chronic abuse causes CNS damage - paranoia, violent behavior 