Poisoning

1
Poisoning

• Temple College
• EMS Professions

2
Poisons

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

3
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

4
Treat Patient, Not Poison

• Proper support of ABCs is first step in management

5
Try to determine

• What?
• How much?
• How long ago?
• What has already been done?
• Psychiatric history?
• Underlying illness?

6
When in doubt. . .

• Assume containers were full
• Entire contents were ingested

7
If several patients involved. . .

• Assume each ingested entire container contents

8
Always. . .

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

9
Poisoning Management

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

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Ingested Poisons

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

11
Activated Charcoal

• Adsorbs toxin, prevents absorption from GI tract

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Activated Charcoal

• Names
• SuperChar
• InstaChar
• Actidose
• Liqui-Char

13
Activated Charcoal

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

14
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

15
Activated Charcoal

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

16
Activated Charcoal

• Side Effects
• Nausea, vomiting
• Black stools

17
Activated Charcoal

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

18
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

19
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

20
Syrup of Ipecac

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

21
Absorbed Poisons

• Dry chemicals
• dust skin, then
• wash
• Liquid chemicals
• wash with large amounts of H20
• avoid neutralizing agents

CAUTION Dont
accidentally expose yourself!
22
Inhaled Poisons

• Remove patient from exposure
• Maximize oxygenation, ventilation

CAUTION Dont
accidentally expose yourself!
23
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

24
Drug Abuse/Overdose
25
Substance Abuse

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

26
Substance Abuse

• Psychological dependence
• Physical dependence
• Compulsive drug use
• Tolerance
• Addiction

27
Psychological Dependence

• Habituation
• Substance needed to support users sense of
  well-being

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Physical Dependence

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

29
Compulsive Drug Use

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

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Tolerance

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

31
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

32
Ethyl Alcohol (EtOH)
33
Ethyl AlcoholA CNS Depressant Drug
34
Ethanol Intoxication Signs

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

35
Ethanol

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

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Patient is NEVER just drunk until all other
possibilities are excluded
37
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

38
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

39
Narcotics

• Opium
• Opium derivatives
• Synthetic compounds that produce opium-like
  effects

40
Narcotics

• Opium
• Heroin
• Morphine
• Demerol
• Dilaudid

• Percodan
• Codeine
• Darvon
• Talwin

41
Narcotics

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

42
Narcotics

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

43
Narcotics

• Withdrawal
• Agitation
• Anxiety
• Abdominal pain
• Dilated pupils

• Sweating
• Chills
• Joint pains
• Goose flesh

Resembles severe influenza
Not a life-threat
44
Barbiturates

• Nembutal
• Seconal
• Pentobarbital
• Amytal
• Tuinal
• Phenobarbital

45
Barbiturates

• Induce sleepiness, state similar to EtOH
  intoxication
• Medical uses
• Anesthetics
• Sedative
• Hypnotics

46
Barbiturates

• Overdose
• Coma
• Respiratory depression
• Shock
• Extremely dangerous in combination with EtOH

47
Barbiturates

• Withdrawal
• Resembles EtOH withdrawal (DTs)
• Extremely dangerous

48
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

49
Tranquilizers

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

50
Tranquilizers

• Overdose
• Unlikely to cause respiratory arrest alone
• Extremely dangerous with EtOH
• Withdrawal
• Resembles EtOH withdrawal
• Extremely dangerous

51
CNS Stimulants Amphetamines

• Dexedrine, Benzedrine, Methyl amphetamine
• Relieve fatigue, promote euphoria, reduce
  appetite

52
CNS Stimulants Amphetamines

• Overdose
• Restlessness, paranoia
• Tachycardia
• Hypertension CVA, Heart failure
• Hyperthermia Heat stroke
• Withdrawal
• Lethargy
• Depression

53
CNS Stimulants Cocaine

• Stronger stimulant effects than amphetamines
• Can cause respiratory/cardiovascular failure,
  heat stroke, lethal arrhythmias

54
CNS Stimulants Cocaine

• Snorting can destroy nasal septum, cause
  massive nosebleed
• Withdrawal
• lethargy
• depression

55
Hallucinogens

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

56
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

57
Solvents

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

58
Solvents

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