EMT: Toxicology- chapter 21

Alcohol can damage the liver, whether thorough chronic overuse or occasional heavy use (binge drinking).

"Binge use" can be "more damaging" than chronic use, -depending on the frequency of the binging and the surrounding circumstances.

These agents are inhaled instead of ingested or injected.

"abused" inhalants -Acetone, -toluene, -xylene, -hexane

naloxone: Should only be used when the patient has

"agonal respirations" =gasping -or is "apneic"

Deaths caused by "chronic poisoning" in adults have been rising as a result of

"drug abuse". -chronic poisoning is more common

Cocaine may be taken in a number of different ways.

- absorbed through all mucous membranes and even across the skin -Immediate effects include excitement and euphoria and "last less than an hour" -Smoked crack is the most potent.

ingested poison: Signs and symptoms include

- burns around the mouth, -gastrointestinal pain, -vomiting, -cardiac dysrhythmias, and -seizures.

Signs and symptoms of absorbed and surface contact poisons

-A history of exposure -Liquid or powder on a patient's skin -Burns -Itching -Irritation -Redness of skin -Typical odors of the substance

DTs/delirium tremens are characterized by:

-Agitation and restlessness -Fever -Sweating -Tremors -Confusion/disorientation -Delusions/hallucinations -Seizures

tx: absorbed and surface contact poisons

-Avoid contaminating yourself or others. -Remove the "substance" from patient as rapidly as possible. -Remove all "contaminated clothing". -Flush and wash the skin.

Alcohol is a powerful CNS *depressant.*

-Decreases activity and excitement -Induces sleep -Dulls the sense of awareness, slows reflexes, and reduces reaction time -May cause aggressive and inappropriate behavior and lack of coordination -Alcohol increases the effects of other drugs and is commonly taken with other substances.

Some patients use inhaled poisons to commit suicide in a vehicle.

-Exhaust fumes= carbon monoxide. -Chemicals or detergent in a tightly sealed vehicle create a type of gas chamber. -When you open the door, you may be overcome as well.

stimulant -Frequently cause

-HTN -tachycardia, and -dilated pupils

Sympathomimetics ( epi, albuterol, amphetamine, cocoaine) = signs and sxs of overdose

-HTN -Tachycardia -dilated pupils -agitation or seizures -hyperthermia

Exposure by injection includes

-IV drug abuse -envenomation by insects, arachnids, and reptiles.

some common trade names for activated charcoal are

-InstaChar, -Actidose, and -LiquiChar.

Injected poisons: tx

-Monitor the airway, -provide high-flow oxygen, -be alert for nausea and vomiting. -Remove rings, watches, and bracelets from areas around the injection site "if swelling occurs".

Signs and symptoms: Hydrogen sulfide Poisoning

-Nausea and vomiting, -confusion, -dyspnea, -loss of consciousness, -seizures, -shock, -coma, and -cardiopulmonary arrest

prior to administering naloxone

-Place an "oropharyngeal airway" and -ventilate the patient using a "BVM"

Many chemical burns occur in an industrial setting.

-Safety showers and specific protocols for handling surface burns may be available. -HazMat team should be available to assist you. -Ensure that you, your team and the patient are thoroughly decontaminated. -After decontamination, promptly transport to the ED for definitive care. -Obtain material safety data sheets.

Before you give a patient charcoal, obtain approval from medical control.

-Shake the bottle vigorously. -You may need to convince the patient to drink it, but never force it. -Record the time when you administered activated charcoal. -If the patient refuses activated charcoal, document the refusal and transport the patient for further evaluation.

absorbed and surface contact poisons

-Skin, mucous membrane, or eye damage -Chemical burns -Rashes or lesions -Systemic effects -It is important to distinguish between contact burns and contact absorption.

ingested poison: Signs and symptoms vary with:

-Type of poison -Age of the patient -Time that has passed since ingestion

tx for pts- abused inhalants

-Use a stretcher to move the patient, -give oxygen, -and transport to the hospital.

Cholinergics -signs and sxs of overdose

-airway compromise -SLUDGEM

Sympathomimetics (*stimulants*) include

-amphetamines, -methamphetamines, -phentermine hydrochloride, and -Benzedrine -Designer drugs, such as "MDMA", are also frequently abused.

If dry powder has been spilled,

-brush off the powder, - flood the area with water for *15 to 20 minutes*, -then wash skin with soap and water.

sedative hypnotic drugs -Patient may appear?

-drowsy, -peaceful, or - intoxicated.

sedative hypnotic drugs- tx

-ensure airway is patent, -assist ventilation, -provide prompt transport.

Pt with alcohol "withdrawal" experience

-frightening hallucinations, or -delirium tremens -DTs

"abused" inhalants found in?

-glues, -cleaning compounds, -paint thinners, and -lacquers -Gasoline and halogenated hydrocarbons are also abused.

"Acute overdose" is a genuine emergency.

-high risk of seizures, -cardiac dysrhythmias, and -stroke. -hallucinations or paranoia. -Do not leave the patient unattended./Provide prompt transport.

Opiates/opioids= signs/sxs of overdose

-hypoventilation or respiratory arrest -pinpoint pupils -sedation or coma -hypotension

Synthetic opioids include

-meperidine, -hydromorphone, -oxycodone, -hydrocodone, and -methadone.

If you suspect "exposure" to a "toxic substance",

-notify medical control -begin emergency treatment.

Prescription opioid drugs are among the most commonly abused drugs in the United States.

-people can become physically dependent on opioids after taking an appropriate medical prescription. -The death rate from heroin overdoses tripled between 2010 and 2013.

SLUDGEM

-salivation, sweating -lacrimation -urination -defecation, drooling, diarrhea -gastric upset and cramps -emesis -muscle twitching/ miosis= pinpoint pupils

opioid Patients typically appear

-sedated or unconscious -cyanotic with -pinpoint pupils.

Sedative-hypnotics: signs and sxs of overdose

-slurred speech -sedation or coma -hypoventilation -hypotension

Anticholinergics -signs and sxs of overdose

-tachycardia -hyperthermia -HTN -dilated pupils -dry skin and mucous membranes -sedation, agitation, seizures, coma, or delirium -decreased bowel sounds

injected poisons: Signs and symptoms may include

-weakness, -dizziness, -fever/chills, -unresponsiveness, -and excitability.

The usual dose for an adult or child is ___ of activated charcoal "per kilogram of body weight"

1 g -1g/ kg (body weight)

__ to __ for activated charcoal to children

15 to 30 g

__ to __ for activated charcoal to adults

30 to 100 g

If local protocol permits, you will likely carry plastic bottles of "premixed suspension", each containing up to ___ of activated charcoal.

50 g

what should you do if pt is trying to commit suicide by carbon monoxide poisoning in car

Contact HazMat responders and *have them remove the victim.*

If you suspect the presence of a toxic gas, call for specialized resources such as the

HazMat team. -Some patients may need decontamination by the HazMat team after removal from the toxic environment.

A highly toxic, colorless, and flammable gas with a distinctive rotten-egg odor

Hydrogen sulfide

Cannot be diluted or removed from the body in the field

Injected poisons

Usually "absorbed quickly" into the body or cause intense local tissue destruction

Injected poisons

Synthetic Cathinones= Bath Salts similar to

MDMA. -Sold as bath salts to escape the legal restrictions imposed on illicit drugs

Hydrogen sulfide Poisoning: Once the patient has been decontaminated, management is largely supportive.

Monitor and assist the patient's "respiratory and cardiovascular" functions. -Provide rapid transport.

____ is an antidote that reverses the effects of opiate or opioid overdose.

Naloxone -Can be given intravenously, intramuscularly, or intranasally -In many EMS systems, EMTs administer naloxone by the "intranasal route".

a toxic dose of a drug.

Overdose:

any substance whose chemical action can "damage body structures" or impair body "function"

Poison:

the misuse of any substance to produce a desired effect.

Substance abuse

_____ are CNS stimulants that mimic the effects of the sympathetic (fight-or-flight) nervous system.

Sympathomimetics -*stimulants*

study of toxic or poisonous substances.

Toxicology

a "poisonous substance" produced by "bacteria, animals, or plants"

Toxin:

____ the poison from the patient's skin.

Wash or brush

If you suspect the presence of a toxic gas, wait for

a HazMat team to tell you the scene is safe

A person with an ____ has an overwhelming need to continue using the substance, at whatever cost.

addiction -Almost any substance can be abused.

Consider inserting an ___ in unresponsive patients.

airway adjunct -Have suction available; these patients are susceptible to vomiting.

sedative hypnotic drugs

barbiturates and benzodiazepines -CNS depressants can alter the level of consciousness.

Activated charcoal

binds to specific "toxins", which are then carried out of the body in the stool.

taking activated charcoal- Side effects are

constipation and black stools.

Poisoning in children has ___ steadily since the 1960s due to child-resistant caps.

decreased

ingested poison- Usually accidental in children and __ in adults

deliberate

The most important treatment you can perform for a poisoning is

diluting and/or physically removing the poisonous agent.

A well-trained ____ can obtain information on a poisoning call

dispatcher -Proper protection needed -Information pertaining to the MOI/NOI -Number of patients involved -If additional resources are needed -Whether trauma is involved

1 in 10 deaths among "working-age adults" in the United States can be attributed to

excessive alcohol use.

If liquid has been spilled onto the skin,

flood for 15 to 20 minutes.

If the patient may have an "inhalation injury", place the patient on

high-flow oxygen "regardless of the pulse oximetry" reading. -You may have to assist ventilations with a "BVM" because some substances act as "depressants".

How you provide treatment for poisoning depends on

how the poison got into the patient's body in the first place. Four routes to consider: -Inhalation -Absorption -Ingestion -Injection

Consider activated charcoal for

ingestions.

Hydrogen sulfide Poisoning usually occurs by

inhalation. -Used to commit suicide

If a chemical agent is introduced to the eyes,

irrigate them quickly and thoroughly.

Hydrogen sulfide affects all organs, but it has the most impact on the

lungs and CNS.

Halogenated hydrocarbon solvents can .

make the "heart hypersensitive" to the patient's own "adrenaline" -Even the action of walking may cause a "fatal ventricular dysrhythmia".

Contact __ or ___ to discuss treatment options for poisoning

medical control or a poison center

Most often, you will not be administering a specific antidote because

most poisons do not have one. -Definitive treatment can only be provided at the ED, so transport promptly.

Presence of injuries at the patient's ____ suggests the "ingestion of a poison"

mouth

About 80% of poisoning is by

mouth- "ingested poisons" -Liquids -Household cleaners -Contaminated food -Plants -Drugs

sedative hypnotic drugs generally taken by

mouth. -Occasionally, the capsules are suspended or dissolved in water and injected. -IV sedative-hypnotic drugs quickly induce tolerance.

Sympathomimetics (*stimulants*) Commonly taken by

mouth; -also injected by drug abusers

inhaled poisons- tx

move into "fresh air immediately". - supplemental oxygen. -Make sure a suctioning unit is available. -Use self-contained breathing apparatus to protect yourself from poisonous fumes.

The medication antidote most commonly available to prehospital providers is

naloxone (Narcan), - "opioid overdose".

An ____ is a subset of the opioid family, and refers to *natural*, nonsynthetic opioids.

opiate

An ___ is a type of narcotic medication used to relieve pain.

opioid -Named for the opium in poppy seeds, from which "codeine and morphine" are derived

Dilute airborne exposures with

oxygen.

Activated charcoal is not indicated for patients:

pt that ingested -alkali poisons, -cyanide, -ethanol, -iron, -lithium, -methanol, -mineral acids, or -organic solvents *Who have a decreased LOC and "cannot" protect their airway*

opioids are CNS depressants and can cause severe

respiratory depression and then cardiac arrest if not treated promptly -Often cause nausea and vomiting -May lead to hypotension -seizures are uncommon, but can occur.

If a patient exhibits signs of serious CNS depression, you must provide

respiratory support. -May cause vomiting -Internal bleeding should be considered if patient appears to be in shock

These drugs may be given to people as a "knock-out" drink.

sedative hypnotic drugs

Known drug abusers have a fairly high incidence of

serious and undiagnosed infections, including HIV and hepatitis. -Always wear the appropriate PPE. -Expect the unexpected. (spitting, biting)

A ____ is an agent that produces an excited state.

stimulant

Remove _____ from the patient's mouth.

tablets or fragments

"abused" inhalants common among?

teenagers

Over time, a person who routinely misuses a substance may need increasing amounts of it to achieve the same result. aka?

tolerance.

If the patient has ingested a poison that causes nausea, he or she may ___ after taking charcoal.

vomit -The dose will have to be repeated.

Remove contact exposures with

water.