chapter 23 - poisoning & od

7/26/2019 Chapter 23 - Poisoning & OD

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Copyright 2012 by Pearson Education, Inc.

All rights reserved.

Emergency Care, Tel!th Edition

"i##er $ %&'ee!e $ (ic)inson

Introduction to EmergencyIntroduction to Emergency

Medical CareMedical Care

11


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OBJECTIVESOBJECTIVES

23.1 (e!ine )ey ter#s introduced in this chapter. *lides

12, 1+, 2, 1, -+, , /+

23.2 (escribe ays in hich poisons can enter the body.

*lide 1

23.3 Identi!y potential dangers to E* providers and

others at scenes here poisoning, alcohol abuse, or

substance abuse is involved. *lides 2, , 2, 2

continued


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23.4 Collect )ey ele#ents in the history o! a patient ho

has been poisoned. *lides 120, -

23.5 (escribe the use o! activated charcoal in the

#anage#ent o! ingested poisons. *lides 22

23. E3plain the #anage#ent o! patients ho have

ingested a poison. *lides 222

continued


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23.! (evelop a plan !or #anaging patients ho have

inhaled poisons. *lides , -0, -

23." (evelop a plan !or #anaging patients ho have

absorbed poisons through the s)in. *lide -

23.# (escribe the health ris)s associated ith alcohol

abuse. *lides 02

continued


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23.1$ 4ecogni5e the signs and sy#pto#s o! alcohol

abuse and ithdraal. *lides -+

23.11 4ecogni5e signs, sy#pto#s, and health ris)s

associated ith abuse o! substances, including

sti#ulants, depressants, narcotics, volatile

che#icals, and hallucinogens. *lides /+/

continued


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23.12 6iven a variety o! scenarios, develop a treat#ent

plan !or patients ith e#ergencies related to alcohol

and substance abuse. , 02


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M%&TIME'I(M%&TIME'I(

$ *lide Cocaine 7ideo


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CO)E CO*CE+TS

$ 8o to )no i! a patient has been

poisoned

$Assess#ent and care !or ingested poisons$ Assess#ent and care !or inhaled poisons

$ Assess#ent and care !or absorbed

poisons

continued


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CO)E CO*CE+TS

$ Assess#ent o! in9ected poisons

$ Assess#ent and care !or alcohol abuse

$ Assess#ent and care !or substanceabuse


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TopicsTopics

$ Poisoning

$ Alcohol and *ubstance Abuse


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+oi,oning+oi,oning


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PoisonPoison

$ A poison is any substance that can har#

the body

$ The har# it can cause can result in a

#edical e#ergency

$ :All things are poison and nothing is

ithout poison, only the dose per#its

so#ething not to be poisonous.;

Paracelsus


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Co##on PoisonsCo##on Poisons

$ edications

$ Petroleu# products

$ Cos#etics$ Pesticides

$ Plants

$


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E!!ects o! a PoisonE!!ects o! a Poison

$ 8ar# to body based on nature o! poison,

concentration, route o! entry, patient&s age

and health

$ (a#age to s)in and tissues !ro# contact

$ *u!!ocation

$ "ocali5ed or syste#ic da#age to bodysyste#s


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Classi!ication o!Classi!ication o!

Poisons =>y 4outes o! Entry?Poisons =>y 4outes o! Entry?

$ Ingested

$ Inhaled

$ Absorbed$ In9ected


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Ingested PoisonIngested Poison

$ Child@ #ay accidentally eat or drin) a to3ic

substance

$ Adult@ o!ten an accidental or deliberate

#edication overdose


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Assess#ent@Assess#ent@

Ingested PoisonsIngested Poisons$ hat substance as involvedB

"oo) !or container chec) labels

Transport ith patient to hospital

$ hen did e3posure occurB

Duic)acting poison reFuires !aster treat#ent

E4 personnel need to )no !or appropriate

testing and treat#ent

continued


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Ingested PoisonsIngested Poisons$ 8o #uch as ingestedB

Esti#ate #issing pills by loo)ing at

prescription label

$ %ver ho long a ti#eB

Treat#ents #ay vary

$ as #edication ta)en !or very !irst ti#eB

$ as #edication being ta)en chronicallyB

continued


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Ingested PoisonsIngested Poisons$ hat interventions have been ta)enB

Treat#ents indicated on label,

%ther ho#e re#edies =syrup o! ipecac?

$ hat is patient&s eightB

4ate o! onset o! to3ic e!!ects is related to

eight

continued


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Ingested PoisonsIngested Poisons$ hat e!!ects has patient e3periencedB

Gausea, vo#iting, altered #ental status,

abdo#inal pain, diarrhea, che#ical burns

around #outh, unusual breath odors


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Treat#entTreat#ent--


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Activated CharcoalActivated Charcoal

$ or)s through adsorption, alloing

substances to attach to its sur!ace

$ Not an antidote@ prevents or reduces

a#ount o! poison absorbed by body


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Treat#ent@ Activated CharcoalTreat#ent@ Activated Charcoal

continued


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continued


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continued


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Thin) About ItThin) About It

$ Thin) about your on ho#e. Is it sa!e !or a

s#all childB

$ Are there potential poisons ithin three

!eet o! the !loor, or behind unloc)ed

doorsB

$ Are there household cleaners that loo)

li)e 9uices and drin)s !a#iliar to childrenB

continued


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Thin) About ItThin) About It

$ Can !lavored children&s #edications be

#ista)en !or candyB

$ hat sense does a s#all child typically

use to identi!y thingsB


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Public EducationPublic Education

$ any E* agencies are involved in

educating the public to the dangers o!

child poisoning

$ Childproo!ing ho#es

$ r. Hu)


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Inhaled PoisonsInhaled Poisons

$ Co##on types

Carbon #ono3ide

A##onia

Chlorine

Agricultural che#icals and pesticides

Carbon dio3ide


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*cene *a!ety*cene *a!ety

$ Approach scene ith

caution

$ Protective clothing

and sel!containedbreathing apparatus

#ay be reFuired

$ I! not trained or

eFuipped, call !or

additional resources


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*igns and*igns and

*y#pto#s@ Inhaled Poisons*y#pto#s@ Inhaled Poisons$ (i!!iculty breathing

$ Chest pain

$ Coughing$ 8oarseness

$ 8eadache, con!usion, altered #ental

status$ *ei5ures


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Assess#ent@ Inhaled PoisonsAssess#ent@ Inhaled Poisons

$ hat substance is involved =e3act na#e?B

$ hen did e3posure occurB

$ %ver ho long did e3posure occurB$ hat interventions has anyone ta)enB

$ 4e#ove patientB

$ 7entilate areaB$ hat e!!ects is patient e3periencingB


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Treat#ent@ Inhaled PoisonsTreat#ent@ Inhaled Poisons

$ ove patient !ro# unsa!e environ#ent

using trained and eFuipped personnel

$ %pen airay provide high !lo o3ygen

$ 8istory, physical e3a#, vital signs

$ Transport ith all containers, bottles, and

labels$ %ngoing assess#ent en route


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Carbon ono3ideCarbon ono3ide

=C%? Poisoning=C%? Poisoning

$ Colorless, odorless, tasteless gas created

by co#bustion

$ Can be caused by i#proper venting o!

!ireplaces, portable heaters, generators

$ Co##on cause o! death during inter and

poer outages


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*igns and*igns and

*y#pto#s@ C% Poisoning*y#pto#s@ C% Poisoning$ 8eadache =band around head?

$ (i55inessnausea

$ >reathing di!!iculty$ Cyanosis

$ ay be #ultiple patients ith si#ilar

sy#pto#s in con!ined area together


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C% onitorC% onitor

$ *o#e !ireE*

syste#s have

#onitoring devices

that allo cres todeter#ine C%

e3posure levels in

the !ield


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C% (etectorsC% (etectors

$ Public education progra#s should

encourage people to have both s#o)e

and C% detectors in their ho#es to reduce

the ris) o! in9ury and death


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Treat#ent@ C% PoisoningTreat#ent@ C% Poisoning

$ 8igh !lo o3ygen is appropriate treat#ent,

but C% bonds to red blood cells #uch

#ore strongly than o3ygen does

$ Can ta)e several hours or days to :ash;

C% !ro# bloodstrea#


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*#o)e Inhalation*#o)e Inhalation

$ *#o)e !ro# burning #aterials can contain

poisonous and to3ic substances, including

C%, a##onia, chlorine, cyanide

$ *ubstances can irritate s)in and eyes,

da#age lungs, and progress to respiratory

or cardiac arrest


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*igns and*igns and

*y#pto#s@ *#o)e Inhalation*y#pto#s@ *#o)e Inhalation$ (i!!iculty breathing

$ Coughing

$ :*#o)y; or che#ical s#ell on breath$ >lac) =carbon? residue in #outh, nose or

sputu#

$ *inged nasal or !acial hair


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Treat#ent@ *#o)e InhalationTreat#ent@ *#o)e Inhalation

$ ove patient to sa!e area

$ aintain airay provide high !lo o3ygen

$ onitor patient closelyJairay burns #aylead to selling o! airay


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::(etergent *uicides;(etergent *uicides;

$ ethod o! suicide started in Kapan and

beco#ing #ore co##on in the L.*.

$ i3 to easilyobtained che#icals to

release hydrogen sul!ide gas

$ Co##only released inside enclosed

space such as a car


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::(etergent *uicides;@(etergent *uicides;@

*cene *a!ety*cene *a!ety

$ E3posure to !u#es #ay in9ure E*

personnel

$ arning note #ay be le!t on vehicle, but

this is not assured

$ ay need to treat !irst as a ha5#at scene


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Absorbed PoisonsAbsorbed Poisons

$ Can be absorbed through s)in

$ ay or #ay not cause da#age to s)in

$ Patient #ay reFuire deconta#ination priorto treat#ent


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Treat#ent@ Absorbed PoisonsTreat#ent@ Absorbed Poisons

$ Assess !or i##ediate li!e threats

$ 8istory, physical e3a#, vital signs

$>rush o!! poder, then irrigate

$ Irrigate s)in and eyes !or at least 20

#inutes and during transport

$ Transport ith all containers$ %ngoing assess#ent en route


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Poison Control CentersPoison Control Centers

$ E3cellent resource

$ In!or#ation on poisons, signs and

sy#pto#s, and treat#ents

$


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(lcool and Su/,tance(lcool and Su/,tance

(/u,e(/u,e


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Alcohol and *ubstance AbuseAlcohol and *ubstance Abuse

$ *ee #any patients hose conditions are

caused either directly or indirectly by

alcohol or substance abuse

$ Abuse o! alcohol and other drugs crosses

all geographic and econo#ic boundaries


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Alcohol AbuseAlcohol Abuse

$ Potent drug a!!ects central nervous

syste#

$ Can be addictive

$ E#ergencies #ay result !ro# recent

consu#ption or years o! abuse

$ Treat patients as any others

$ Abuse can lead to or orsen other

#edical conditionscontinued


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Alcohol AbuseAlcohol Abuse

$ Alcohol o!ten consu#ed ith other drugs,

hich can result in a serious #edical

e#ergency

$ I#paired patients can be uncooperative or

co#bative

$ Contact la en!orce#ent i! sa!ety concern


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Assess#ent@ Alcohol AbuseAssess#ent@ Alcohol Abuse

$ any #edical conditions #i#ic alcohol

into3ication

$ Into3icated patients #ay also have

#edical proble#s

$ All patients receive !ull assess#ent

regardless o! suspicion o! into3ication


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*igns and*igns and

*y#pto#s@ Alcohol Abuse*y#pto#s@ Alcohol Abuse$ Alcohol odor on breath

$ Lnsteady on !eet

$ *lurred, ra#bling speech

$ lurred vision

$ Con!usionaltered #ental status


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Alcohol ithdraalAlcohol ithdraal

$ Abrupt cessation o! drin)ing #ay cause

so#e alcoholics to su!!er !ro# deliriu#

tre#ens =(Ts?

$ Can be serious, resulting in tre#ors,

hallucinations, and sei5ures


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*igns and*igns and

*y#pto#s@ Alcohol ithdraal*y#pto#s@ Alcohol ithdraal

$ Con!usion and restlessness

$ Lnusual behavior, de#onstrating :insane;

behavior

$ 8allucinations, gross tre#or o! hands,

pro!use seating

$ *ei5ures


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Patient Care@ Alcohol AbusePatient Care@ Alcohol Abuse

$ 7o#iting co##on standard precautions

are essential

$ 'eep suction ready

$ *tay alert !or airay and respiratory

proble#s

$ onitor vital signs

$ 6ather history !ro# patient, bystanders

$ *tay alert !or sei5ures


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*ubstance Abuse*ubstance Abuse

$ Any che#ical substance ta)en !or other

than therapeutic =#edical? reasons

$ Includes illicit

drugs, prescription

#edications,

industrial

che#icals


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LppersLppers

$ *ti#ulants that a!!ect the nervous syste#

$ Cocaine

$ A#pheta#ines

$ ay be snorted, s#o)ed, or in9ected


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(oners(oners

$ Central nervous syste# depressants

$ >arbiturates

$ 4ohypnol =4oo!ies?

$ 68>


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GarcoticsGarcotics

$ Lsed to relieve pain or help ith sleep

$ %piates

8eroin, codeine, #orphine

$ %3ycodone


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8allucinogens8allucinogens

$ Create intense state o! e3cite#ent and

distorted perception

$ "*(, PCP, MTC


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Emergency Care, Tel!th Edition"i##er $ %&'ee!e $ (ic)inson

7olatile Che#icals7olatile Che#icals

$ Produce vapors

that are inhaled

$ Initial :rush,; then

can act as central

nervous syste#

depressant

A tA t


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*ubstance Abuse*ubstance Abuse$ ay be di!!icult

Patient&s level o! consciousness

Patient #ay have ta)en #ore than one type o!

drug

$ Patient #ay be uncooperative or

co#bative

$ >e aare o! a possibility o! conta#inatedneedles and the presence o! che#icals


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Copyright 2012 by Pearson Education, Inc.All rights reserved.


*igns and *y#pto#s@ (oners*igns and *y#pto#s@ (oners

$ *luggishness, poor coordination

$ (ecreased pulse and respirations

*i d*i d


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*igns and*igns and

*y#pto#s@ Lppers*y#pto#s@ Lppers$ E3cite#ent, restlessness

$ Increased pulse and respirations

$ *eating

$ 8yperther#ia

$ Go sleep !or a long ti#e, possibly days

*i d*i d


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*igns and*igns and

*y#pto#s@ Garcotics*y#pto#s@ Garcotics$ "ethargy =patient very sleepy?

$ Pinpoint pupils

$ Cool s)in

$ 4espiratory depression

$ Co#a

*i d*i d


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*igns and*igns and

*y#pto#s@ 8allucinogens*y#pto#s@ 8allucinogens$ 4apid pulse

$ (ilated pupils

$


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*igns and*igns and

*y#pto#s@ 7olatile Che#icals*y#pto#s@ 7olatile Che#icals$ (a5eddisoriented

$ *ollen #e#branes in nose or #outh

$ Gu#bness or tingling sensation inside

head

$ Changes in heart rhyth#

$ ay be residue o! che#ical on !ace or inbag


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Treat#ent@ *ubstance AbuseTreat#ent@ *ubstance Abuse

$ >e aare o! possible airay proble#s and

respiratory distress

$ Provide o3ygen and assist respirations as

needed

$ Treat !or shoc)

$ Tal) to patient to )eep the# cal# and

cooperative

continued


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$ Per!or# physical

e3a#

$ "oo) !or evidence

o! in9ection sites=:trac) #ar)s;?

continued


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$ Transport as soon as possible

$ Consult ith #edical control on !urther

treat#ent

$


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Cocaine 7ideoCocaine 7ideo

Clic) here to vie a video on the sub9ect o! cocaine dependency.

>ac) to (irectory


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Chapter ReviewChapter Review


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Chapter 4evieChapter 4evie

$ Per!or# pri#ary assess#ent and

i##ediately treat li!ethreatening

proble#s. Ensure an open airay.

Ad#inister highconcentration o3ygen i!the poison as inhaled or in9ected.

continued


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continued


$ Per!or# a history and physical e3a#,

including baseline vital signs.


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$ Consult #edical direction. As directed,

ad#inister activated charcoal, ater, or

#il) !or ingested poisons.

$ 4e#ove patient ho has inhaled poison!ro# the environ#ent and ad#inister high

concentration o3ygen re#ove poisons

!ro# s)in by brushing o!! or diluting.

continued


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$ Transport patient ith all containers,

bottles, and labels !ro# substance.

$ 4eassess patient en route.

$ Care!ully docu#ent all in!or#ation about

poisoning, interventions, and patient&s

responses.


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4e#e#ber4e#e#ber

$ *a!ety is alays the !irst concern hen

dealing ith a poisoning or substance

abuse patient.

$ Poisonings are generally classi!ied byroute o! e3posure. E!!ects vary greatly,

depending upon type o! poison and

#ethod o! entrance into body.

continued


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4e#e#ber4e#e#ber

$ ETs #ust use thorough assess#ent,

including scene clues, to help identi!y the

nature and severity o! poisoning.

$ Poison control centers o!!er a ealth o!resources to assist in assess#ent and

treat#ent o! poisoning patient.

continued


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4e#e#ber4e#e#ber

$ Alcohol is a co##on underlying issue ith

patients. In so#e patients it #ay be the

#ost signi!icant proble#.

$ The e!!ects o! substance abuse can varygreatly, based on the type o! substance.

(eter#ining the type o! drug ingested can

shed light on e!!ects to co#e.


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Duestions to ConsiderDuestions to Consider

$ hat are potential ris)s to the responder

on a poisoning or overdose callB

$ hat are the routes o! entry into the

bodyB

$ hat are so#e things E* can do to

prevent poisonings, especially in childrenB


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Critical Thin)ingCritical Thin)ing

$ A !ar#er calls /11 because one o! his !ar#

hands has tried to clean up spilled

pesticide poder ith his hands. %n

arrival, you !ind that the patient insists hehas brushed all the poder o!!, !eels !ine,

and doesn&t need to go to the hospital.

continued


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Critical Thin)ingCritical Thin)ing

$ As he tal)s, he continues to #a)ebrushing #otions at his 9eans on hich

you can see the #ar)s o! a podery

residue. 8o do you #anage thesituationB


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