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Poisonings & Overdose

Poisonings & Overdose. accidental or deliberate. Poison Any substance whose chemical action can damage body structures or impair body functions Substance Abuse The knowing misuse of any substance to produce a desired effect. Routes of Entry. oral ingestion (PO) inhalation

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Poisonings & Overdose

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  1. Poisonings & Overdose accidental or deliberate

  2. Poison • Any substance whose chemical action can damage body structures or impair body functions Substance Abuse • The knowing misuse of any substance to produce a desired effect

  3. Routes of Entry • oral ingestion (PO) • inhalation • injection ( IV, SC, IM, IO) • absorption (SL, transcutaneous, PR)

  4. Ingested Poison • accounts for 80% of all poisonings • accidental or deliberate • Activated charcoal – NOT used by EMT’s in LA County • ABCs and transport

  5. Inhaled Poisons • Wide range of effects • YOUR safety is 1st • Move to fresh air immediately • Provide airway support and rapid transport • Bring contained agent or label to hospital

  6. Injected Poisons • Usually deliberate (drug OD) • Impossible to remove or dilute • Can be counteracted (ALS) • ABC’s, high flow O2, rapid transport

  7. Absorbed Poisons • Corrosives will damage the skin • Some drugs are absorbed SL or PR • Treat chemical burns • Do not irrigate Phosphorous or elemental Na • ABC’s, O2, rapid transport

  8. Inducing vomiting • not within the EMT-1 scope of practice to induce vomiting • But, is the indicated treatment for many poisonings/overdose THE 3 EXCEPTIONS - next slide please

  9. No Vomiting • ALOC • Pts at risk for seizures • Injested caustics / hydrocarbons

  10. TX – Injested caustics/hydrocarbons • discourage vomiting • drink water or milk if available • rapid transport

  11. Anticholinergics • block the parasympathetic nerves • “Hot as a hare, blind as a bat, dry as a bone, red as a beet, and mad as a hatter” • seizure and death within 30 minutes • Have ALS backup or transport rapidly

  12. Cholinergic Agents • nerve agents for warfare • organophosphate insecticide or wild mushrooms • overstimulate parasympathetic nerves

  13. D Defecation U Urination M Miosis B Bronchorrhea E Emesis L Lacrimation S Salivation S Salivation L Lacrimation U Urination D Defecation G GI irritation E Eye constriction Signs and Symptoms of Cholinergic Poisoning

  14. Rx • SAFETY – avoid exposure • support ABC’s prn • suction • high flow oxygen • rapid transport • may be HazMat

  15. Drug Categories • Narcotics or opiates • Depressants - barbiturates - downers • Stimulants - uppers • Hallucinogens - including PCP • Designer • Hydrocarbons

  16. Narcotics or Opiates • ALOC • respiratory depression/hypoventilation • pinpoint pupils • hypotension • nausea/ vomiting

  17. Depressants (sedative – hypnotic) • ALOC • respiratory depression /hypoventilation • pupils dilated • loss of coordination • slurred speech • bradycardia and hypotension

  18. Stimulants (Sympathomimetics) • agitation & anxiety • dilated pupils • tachycardia • hypertension • rapid speech • seizures

  19. Hallucinogens • blank stare • visual hallucinations • tachycardia, hypertension • anxiety, agitation

  20. Hallucinogens • inappropriate behavior • dilated pupils • nystagmus • hot flashes (equals naked patients) • seizures

  21. Hallucinogen - PCP • phencyclidine • “slow motion man” • fast if violent • increased strength • nystagmus • rebound dilation

  22. Designer Drugs Chemically designed for a specific effect • Ecstasy • GHB Overdose: Respiratory arrest - Hallucinations - ALOC

  23. Hydrocarbons (Abused Inhalants) • paint residue around mouth & hands • smell of paint or glue • coughing • choking

  24. Aspirin • Signs and symptoms • Nausea/vomiting • Hyperventilation • Ringing in ears • Confusion • Seizures • Transport promptly

  25. Acetaminophen • common overdose • not very toxic • liver failure

  26. Rx for All • protect self • ABC’s • high flow oxygen • position of comfort • transport

  27. CO poisoning • headache • confusion • nausea & vomiting • dyspnea, tachypnea, tachycardia • unconsciousness

  28. Rx • protect self • remove patient from source • ABCs • high flow oxygen

  29. Food Poisoning • Salmonella bacterium • Staphylococcus • Botulism

  30. Care for Food Poisoning • History is important • Transport promptly • bring some of the suspected food to the hospital

  31. Plant Poisoning • Several thousand cases each year • Assess the patient’s airway and vital signs. • Notify poison control center. • Take the plant to the emergency department. • Provide prompt transport.

  32. the end Next?

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