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: 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

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

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 AlcoholA CNS Depressant Drug

Decreased ReactionTime

Increased AccidentalTrauma Risk

Decreased SocialInhibitions

Increased IntentionalTrauma Risk

Potentiation of OtherCNS Depressants

Lethal Overdoses inCombination with OtherDrugs

Slowed GI TractActivity

Irritation, Gastritis,Ulcer Disease, GIBleeds

Toxic Overdose RespiratoryDepression, Shock

Ethanol Intoxication Signs 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

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

Alcohol Addicts

Life threatening condition! Occurs 1 days to 2 weeks after intake

is decreased 5 to 15% mortality Control airway, prevent aspiration,

monitor for hypovolemia

Delirium Tremens

Narcotics

Opium Opium derivatives Synthetic compounds that produce

opium-like effects

Narcotics Opium Heroin Morphine Demerol Dilaudid

PercodanCodeineDarvonTalwin

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

Nembutal Seconal Pentobarbital Amytal Tuinal Phenobarbital

Barbiturates

Induce sleepiness, state similar to EtOH intoxication

Medical uses– Anesthetics– Sedative– Hypnotics

Barbiturates

Barbiturates

Overdose– Coma– Respiratory depression– Shock

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

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

Withdrawal– Resembles EtOH withdrawal– Extremely dangerous

Tranquilizers

CNS Stimulants: Amphetamines

Dexedrine, Benzedrine, Methyl amphetamine

Relieve fatigue, promote euphoria, reduce appetite

CNS Stimulants: Amphetamines

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

Withdrawal– Lethargy– Depression

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

CNS Stimulants: Cocaine

LSD, psilocybin, peyote, mescaline, DMT, MDMA

Enhance perception Wrong setting may induce “bad

trips” with extreme anxiety True toxic overdose rare

Hallucinogens

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

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

Solvents