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

10. 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

12. 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 Don’t accidentally expose yourself!

22. Inhaled Poisons • Remove patient from exposure • Maximize oxygenation, ventilation CAUTION Don’t 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 user’s sense of well-being

28. 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

30. 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

36. Patient is NEVER “just drunk” until all other possibilities are excluded

37. 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

38. 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

39. Narcotics • Opium • Opium derivatives • Synthetic compounds that produce opium-like effects

40. Narcotics • Percodan • Codeine • Darvon • Talwin • Opium • Heroin • Morphine • Demerol • Dilaudid

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. Nembutal Seconal Pentobarbital Amytal Tuinal Phenobarbital Barbiturates

45. Induce sleepiness, state similar to EtOH intoxication Medical uses Anesthetics Sedative Hypnotics Barbiturates

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

50. Overdose: Unlikely to cause respiratory arrest alone Extremely dangerous with EtOH Withdrawal Resembles EtOH withdrawal Extremely dangerous Tranquilizers