Poisoning Temple College EMS Professions

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

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

Treat Patient, Not Poison v Proper support of ABCs is first step in management

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

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

If several patients involved... v Assume each ingested entire container contents

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

Poisoning Management v Based on route of entry –Ingested –Absorbed –Inhaled –Injected

Ingested Poisons v 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 v Names –SuperChar –InstaChar –Actidose –Liqui-Char

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

Activated Charcoal v 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 v Contraindications –Altered mental status –Inability to swallow –Ingestion of acids or alkalis v Does not bind –Alcohol –Petroleum products –Metals (iron)

Activated Charcoal v Side Effects –Nausea, vomiting –Black stools

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

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

Syrup of Ipecac v Dose vChildren = 15 cc orally vAdults = 30 cc orally v Repeat once after 20 minutes as needed v Be sure patient has H 2 0 in stomach v Should not be given at same time as activated charcoal

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

Absorbed Poisons v Dry chemicals –dust skin, then –wash v Liquid chemicals –wash with large amounts of H 2 0 –avoid neutralizing agents CAUTION Dont accidentally expose yourself!

Inhaled Poisons v Remove patient from exposure v Maximize oxygenation, ventilation CAUTION Dont accidentally expose yourself!

Injected Poisons v Attempt to slow absorption vVenous constricting bands vDependent position vSplinting of injected body part vCold packs (+) [May worsen local injury by concentrating poison]

Drug Abuse/Overdose

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

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

Psychological Dependence v Habituation v Substance needed to support users sense of well-being

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

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

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

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

Ethyl Alcohol (EtOH)

Ethyl Alcohol A CNS Depressant Drug

Ethanol Intoxication Signs v Breath odor v Swaying, unsteadiness v Slurred speech v Nausea, vomiting v Flushed face v Drowsiness v Violent, erratic behavior

Ethanol v Clouds signs, symptoms v Complicates assessment v 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

v Experience alcohol withdrawal syndrome if they reduce intake: vRestlessness, tremulousness vHallucinations vSeizures vDelirium tremens--all of above plus tachycardia, nausea, vomiting, hypertension, elevated body temperature Alcohol Addicts

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

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

Narcotics v Opium v Heroin v Morphine v Demerol v Dilaudid v Percodan v Codeine v Darvon v Talwin

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

Narcotics v Overdose vComa vRespiratory depression vConstricted (pin-point) pupils

Narcotics v Withdrawal –Agitation –Anxiety –Abdominal pain –Dilated pupils –Sweating –Chills –Joint pains –Goose flesh Resembles severe influenza Not a life-threat

v Nembutal v Seconal v Pentobarbital v Amytal v Tuinal v Phenobarbital Barbiturates

v Induce sleepiness, state similar to EtOH intoxication v Medical uses –Anesthetics –Sedative –Hypnotics Barbiturates

v Overdose –Coma –Respiratory depression –Shock v Extremely dangerous in combination with EtOH

Barbiturates v Withdrawal –Resembles EtOH withdrawal (DTs) –Extremely dangerous

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

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

v Overdose: vUnlikely to cause respiratory arrest alone vExtremely dangerous with EtOH v Withdrawal –Resembles EtOH withdrawal –Extremely dangerous Tranquilizers

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

CNS Stimulants: Amphetamines v Overdose –Restlessness, paranoia –Tachycardia –Hypertension CVA, Heart failure –Hyperthermia Heat stroke v Withdrawal –Lethargy –Depression

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

v Snorting can destroy nasal septum, cause massive nosebleed v Withdrawal: –lethargy –depression CNS Stimulants: Cocaine

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

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

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

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