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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
Dont accidentally expose yourself!

Inhaled Poisons
Remove patient from exposure
Maximize oxygenation, ventilation

CAUTION
Dont 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 users
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 Alcohol
A CNS Depressant Drug
Decreased Reaction
Time

Increased Accidental
Trauma Risk

Decreased Social
Inhibitions

Increased Intentional
Trauma Risk

Potentiation of Other
CNS Depressants

Lethal Overdoses in
Combination with Other
Drugs
Irritation, Gastritis,
Ulcer Disease, GI
Bleeds
Respiratory
Depression, Shock

Slowed GI Tract
Activity
Toxic Overdose

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

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

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

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

Narcotics
Opium
Heroin
Morphine
Demerol
Dilaudid

Percodan
Codeine
Darvon
Talwin

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

Barbiturates
Nembutal
Seconal
Pentobarbital
Amytal
Tuinal
Phenobarbital

Barbiturates
Induce sleepiness, state similar to
EtOH intoxication
Medical uses

Anesthetics
Sedative
Hypnotics

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

Tranquilizers
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

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

CNS Stimulants: Cocaine


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

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

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

Solvents
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