CHAPTER 21 Poisoning and Overdose Emergencies. Poison K ey Term Any substance that can harm the body...
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Transcript of CHAPTER 21 Poisoning and Overdose Emergencies. Poison K ey Term Any substance that can harm the body...
Poison
Key Term
Any substance that can harm the Any substance that can harm the body by altering cell structure or body by altering cell structure or function.function.
Toxin
Key Term
A poisonous substance secreted by A poisonous substance secreted by bacteria, plants or animalsbacteria, plants or animals
General Information
Reactions to poisons are different for all persons, but they are the most severe in the ill and the elderly.
Effects and extent of damage depend upon:
Patient’s age
Patient’s weight
Patient’s general health
Systemic Poisons
Key Term
These poisons cause harm to the These poisons cause harm to the entire body or an entire body systementire body or an entire body system
Four Types of PoisoningFour Types of Poisoning
INHALATION INJECTION
INGESTION ABSORPTION
Drain Cleaners
Rat Poison
Lye
Sprays Cleaning Fluid
Drugs
Household Cleaners
Insecticides
Ingested Poisons
Key Term
Poisons that are swallowed (i.e. Poisons that are swallowed (i.e. acetaminophen, acids/alkalis, acetaminophen, acids/alkalis, antihistamines, aspirin, food antihistamines, aspirin, food poisoning, insecticides, petroleum poisoning, insecticides, petroleum products, plants, etc…products, plants, etc…
History of ingestion
Nausea (most common)
Vomiting (most common)
Diarrhea
Signs & Symptoms of Ingested Poison/Overdose
Signs & Symptoms ofIngested Poison/Overdose
Altered mental status
Abdominal pain
Chemical burns around mouth
Unusual breath odor
Difficulty breathing
Gather information. Remove pills, Gather information. Remove pills, tablets or fragments with gloves from tablets or fragments with gloves from patient’s mouth, as needed, without patient’s mouth, as needed, without injuring oneself.injuring oneself.
Consult medical direction.Consult medical direction.Administer activated charcoal?Administer activated charcoal?
Transport the patient – bring all containers,Transport the patient – bring all containers,bottles, labels, etc… of poison agents to bottles, labels, etc… of poison agents to receiving facility. Position patient for receiving facility. Position patient for vomiting. Save all vomitus. Have suction vomiting. Save all vomitus. Have suction equipment ready.equipment ready.
Information to Gather
What substance involved?
Get exact name and spelling.
Bring container, if possible and safe.
When did exposure occur?
Reaction times of poisons are different. Try to find out as closely as possible the time of ingestion.
Information to Gather
How much did you ingest?
Counting the tablets left in a new container.
Amount spilled on the floor.
If you can’t be exact, give the maximum possible amount.
Over what time period? Has the patient been taking the medication and then overdosed?
Is this a new medication, and the patient overdosed?
Information to Gather
What interventions taken?
Any home remedies?
What is patient’s estimated weight?
Estimate your patient’s weight because it can be critical in the treatment process.
Any effects on patient?
Nausea/vomiting, altered mental status, abdominal pain, diarrhea, chemical burns around the mouth and nose, unusual breath odors
Inhaled Poisons
Key Term
Poisons that are breathed in (i.e. Poisons that are breathed in (i.e. carbon monoxide, ammonia, carbon monoxide, ammonia, chlorine, volatile chemicals); chlorine, volatile chemicals); chemicals that change easily from chemicals that change easily from liquid to gas – industrial solventsliquid to gas – industrial solvents
Signs & Symptoms of Inhaled Poisons
Nausea (most common)
Vomiting (most common)
Difficulty breathing
Chest pain
Cough
Hoarseness
Dizziness
Headache
Confusion
Seizures
Altered mental status
History of inhalation; MOI
Signs & Symptoms of Inhaled Poisons
Most common inhaled poison (motor vehicle exhaust, fire suppression, faulty heaters)
Colorless, odorless, tasteless gas
Prevents normal carrying of red blood cells
Death can occur as hypoxia becomes severe
Carbon Monoxide
Carbon Monoxide Inhalation
Nausea
Vomiting
Headache
Dizziness
Difficulty breathing
Cyanosis
Altered mental status
Unconsciousness
Signs andSymptoms(resemble flu)
Cherry red lips VERY UNCOMMON.
Substances found in smoke can burn the skin
Irritate the eyes
Injure the airway
Cause respiratory arrest
Cause cardiac arrest
Smoke Inhalation
Smoke Inhalation
Difficulty breathing
Coughing
Breath has “smoky” smell or
odor of chemicals involved at the
scene
Black (carbon) residue in patients
mouth and nose
Black (carbon) residue in sputum
coughed up by patient
Nose hairs singed in superheated
air
Signs andSymptoms(can be delayed orImmediate and severe)
Have trained rescuers remove patient Have trained rescuers remove patient from poisonous environment. DO NOT from poisonous environment. DO NOT go unless you have proper apparatus go unless you have proper apparatus and training.and training.
Establish an open airway. Give oxygen, if Establish an open airway. Give oxygen, if not already done in the initial assessment.not already done in the initial assessment.
Give by NRB at 15 lpm.Give by NRB at 15 lpm.
Transport the patient. Bring all containersTransport the patient. Bring all containersbottles, labels, etc… of poison agents to bottles, labels, etc… of poison agents to
receiving facility if you can safelyreceiving facility if you can safelytransport them.transport them.
Information to Gather
What substance involved?
Get exact name and spelling.
Bring container, if possible and safe.
When did exposure occur?
Try to find out what the earliest and latest possible times of exposure were.
Information to Gather
Over how long a period did the exposure occur?
The longer the exposure, the more likely the poison was inhaled
Patient interventions… Did someone ventilate the area?
Did someone remove the patient from the area?
When did this happen?
Information to Gather
Any effects on patient?
Nausea/vomiting, difficulty breathing, chest pain, coughing, hoarseness, dizziness, headache, confusion, seizures, or altered mental status
Injected Poisons
Key Term
Poisons that are inserted through Poisons that are inserted through the skin.the skin.
Emergency Care of Injected Poisons
Secure airway; administer oxygen.
Be alert for vomiting.
Bring all containers, bottles, labels, etc… of poison agents to receiving facility if you can safely transport them.
Absorbed Poisons
Key Term
Poisons that are taken into the body Poisons that are taken into the body through unbroken skin.through unbroken skin.
Signs & Symptoms ofAbsorbed Poisons
History of exposure
Liquid or powder on patient’s skin
Burns
Itching
Irritation
Redness
Difficulty Breathing
Remove patient from source withoutRemove patient from source withoutcontaminating yourself.contaminating yourself.
Remove contaminated clothing and other Remove contaminated clothing and other articles. Be sure to protect oneself.articles. Be sure to protect oneself.
Brush powders from patient, and irrigatewith water for at least 20 minutes.
Emergency Care of Eye Absorption
Irrigate with clean water for at least 20 minutes and continue en route if possible.
Acids and Alkalis
Neutralizing acids or alkalis with solutions (vinegar or baking soda) should not be done.
DO NOT mix acids with alkalis – you may think it could neutralize the reaction, but the reaction produces heat and skin could be futher damaged.
Information to Gather
What substance involved?
Get exact name and spelling.
When did exposure occur?
How much substance was the patient exposed to?
How large an area of skin was covered?
Information to Gather
Over what time period?The longer the substance was on the patient’s skin, the more likely it was absorbed.
Patient interventions… Did someone attempt to wash the poison off? With what?
Did anyone attempt to neutralize the substance?
Information to Gather
Any effects on patient?
Liquid or powder on the patient’s skin, burns, itching, irritation and redness
BE ALERT FOR CONTACT LENSES
When treating a poisoned or overdosed patient, be prepared for deterioration, vomiting, and the need to secure airway.
Airway Management in Poisoning/Overdose
Activated Charcoal
Key Term
A substance that adsorbs (one A substance that adsorbs (one substance becoming attached to the substance becoming attached to the surface of another) many poisons surface of another) many poisons and prevents them from being and prevents them from being absorbed by the bodyabsorbed by the body
Trade Names: SuperChar, InstaChar,Trade Names: SuperChar, InstaChar,LiquiChar, ActidoseLiquiChar, Actidose
Generic Name: Generic Name: Activated Activated CharcoalCharcoal
Activated Charcoal
Indication Poisoning by mouth
Contraindications Altered mental status
Ingestion of acid or alkali (i.e. oven cleaners, drain cleaners, toilet bowl cleaners, lye, etc…)
Patient unable to swallow
Patient who swallowed gasoline while siphoning
Pre-mixed in water,
commonly 12.5
grams in plastic
bottle
Avoid powder form
in the field
Activated Charcoal
MedicationForm
Adults and children: 1 gram activated charcoal/kg of body weight
Adult: 25-50 grams
Pediatric: 12.5-25 grams
Activated Charcoal
Dosage
1. Consult medical direction.
2. Shake container thoroughly.
3. Since medication looks like mud, patient may need to
be persuaded to drink it.
4. A covered container and a straw may improve patient
compliance since the patient cannot see the
medication this way.
5. If patient takes a long time to drink the medication, the
charcoal will settle and will need to be shaken or
stiffed again.
6. Record activity and time.
Activated CharcoalAdministration
Activated Charcoal
Actions Binds to certain poisons;
prevents absorption by body This is not an antidote (a substance that
will neutralize the poison or its effects
It will reduce/prevent the amount of
poison available for the body to absorb
Does not work with all poisons (again
DO NOT use with acids and alkalis)
Not all brands of activated charcoal are
the same; some bind much more poison
that others, so consult medical direction
about the brand to use
The EMT-Basic should be
prepared for the patient to
vomit or further deteriorate
Activated Charcoal
SideEffects
Black stools
Some patients, particularly those who
have ingested poisons that cause
nausea, may vomit
If patient vomits, the dose should be
repeated once
ReassessmentReassessment
StrategiesStrategies
Syrup of Ipecac
Facts
Causes vomiting in most people with one dose
Takes 15-20 minutes to work
On average, it removes less than 1/3 of stomach contents
Because of its slowness, it’s relatively ineffective
Can cause aspiration of vomit into lungs
Syrup of Ipecac
Indication Poisoning by mouth
Contraindications Altered mental status
Ingestion of acid or alkali (i.e. oven cleaners, drain cleaners, toilet bowl cleaners, lye, etc…)
Patient unable to swallow
Obtain order from
medical direction either
on-line or off-line
Record activity and
time
Syrup of Ipecac
Administration
Should be prepared for the patient to
vomit or further deteriorate
Reassessment Strategies
A substance that will neutralize the poison
or its effects
Only a few genuine antidotes exist, and
they only work with a small number of
poisons
Antidote versus Dilution
Antidote
Thinning down or weakening by mixing with
something else
Usually used with ingested poisons
Should use water or milk
Adult dosage should be 1-2 glasses
Pediatric dosage should be ½ to 1 glass
Dilution
Alcohol AbuseEmergencies can result from:
Due to the effect of the alcohol just consumed
Resulting from the cumulative effects of years of alcohol abuse
Provide care for the patient suffering from alcohol abuse/overdose the same as you would for any other patient
Effects of Alcohol Immediate effect is CNS depression
Injuries and falls
Derangements of blood sugar (chronic abusers)
Poor nutrition (chronic abusers)
Potential for considerable GI bleeding (chronic abusers)
Having a heart attack
Hypoglycemia
If combined with other depressants (antihistamines/tranquilizers) effects are exacerbated
Signs & Symptoms of Alcohol Abuse
Odor of alcohol on patient’s breath/clothing
Swaying/Unsteadiness of movement
Slurred speech, rambling thoughts and incoherent words/phrases
Flushed appearance
Nausea and vomiting
Poor coordination
Slowed reaction time
Blurred vision
Confusion
Hallucination (visual/auditory)
Lack of memory
Altered mental status – decreased level of consciousness
All of these signs & symptoms could be serious medical problems as well!
Signs & Symptoms of Alcohol Withdrawal
Confusion/Restlessness
Unusual behavior
Hallucination
Gross Tremor (obvious shaking) of the hands
Profuse sweating
Seizures
Problems Associated withAlcohol Withdrawal
Patients may suffer from delirium tremens (DT’s).
A severe reaction that can be a part of alcohol withdrawal. It is characterized by sweating, trembling, anxiety, and hallucinations.
All patients with DT’s must be transported to a medical facility ASAP
Can be fatal.
Special Circumstances with Alcohol Abuse
Some conditions may make the patient appear to be intoxicated when he/she is not. Don’t let the presence of alcohol or the signs/symptoms of alcohol abuse override suspicions of other medical problems/injuries
Diabetes
Epilepsy
Head Injuries
High Fever
Hypoxia
Emergency Care ofAlcohol Overdose
A patient under the influence of alcohol cannot make an informed refusal of treatment or transport!
You must treat by implied consent!!!
The condition may worsen as alcohol is absorbed into the blood stream (i.e. head injuries can lead to subdural hematomas)
Substance Overdose
A chemical substance that is being taken for other than therapeutic (medical) reasons
Most common substances are: Uppers & Downers Narcotics Hallucinogens Volatile Chemicals
UppersUppers – Stimulants such as amphetamines that affect the CNS to excite the user, relieve fatigue or to create the feeling of well-being
Include caffeine, cocaine, & amphetamines
Signs and Symptoms
Excitement
Increased heart rate
Increased breathing rate
Rapid speech
Dry mouth
Dilated pupils
Sweating
Complaint of having gone without sleep for long periods
Downers
Downers – Have a depressant effect on the CNS; relaxing agent, sleeping pill, tranquilizer; produces a sense of euphoria and sometimes hallucinations
Includes Rohypnol, barbiturates, GHB, etc…
Signs and symptoms
Sluggish
Sleepy patient lacking typical coordination of body and speech
Decreased pulse (often to point of a true emergency)
Decreased respiration (often to point of a true emergency)
Stupor
NarcoticsDrugs capable of producing stupor or sleep often used to relieve pain and to quiet coughing; intense state of relaxation and well-being
Include heroin, codeine, & oxycodone
Opiate Triad
Coma
Pinpoint Pupils
Respiratory Depression
Signs and symptoms
Decreased heart rate, respiratory rate and skin temperature
Pinpoint pupils
Relaxed muscles
Profuse sweating
Patient is sleepy and doesn’t want to do anything
HallucinogensMind-affecting drugs that act on the nervous system to produce an intense state of excitement or a distortion of the user’s perceptions
Include PCP, LSD, & ecstasy
Signs and symptoms
Increased heart rate
Dilated pupils
Flushed face
Patient often “sees” and “hears” things
Patient has little concept of time
Patient may not be aware of true environment
Patient may become aggressive or timid
Volatile ChemicalsGive an initial “rush” then act as a depressant on the CNS
Include glue, cleaning fluid, model cement, typing correction fluid, propane, etc…
Signs and symptoms
Dazed or showing temporary loss of contact with reality
Develop coma
Linings of nose/mouth may show swollen membranes
Patient complains of “funny numb feeling” or “tingling” inside head
Changes in heart rhythm
Emergency Care ofSubstance Overdose
Ensure scene safety; restrain patient if needed.
Assess for respiratory compromise.
Monitor level of consciousness.
Continued…