EMT Chapter 21: Poisoning and Overdose Emergencies

What are the emergency care steps for inhaled poisoning? For absorbed poisoning?

-Emergency care steps for an inhaled poisoning include removing the patient from the source of the poison, establishing an open airway, and inserting an OPA or NPA. Administer oxygen as appropriate. Gather the patient's history, take vital signs, expose the chest for auscultation, and contact medical direction. Transport. -Emergency care steps for an absorbed poisoning include removing the patient from the source of the poison while avoiding your own cross-contamination. Always brush powders from the patient, being careful not to abrade the patient's skin. Remove contaminated clothing. Irrigate with clear water for at least 20 minutes while catching contaminated water and disposing of it safely. Contact medical direction and transport.

What if the snake was a coral snake and the poison information specialist told you the venom affects primarily the nervous system? What signs and symptoms should you anticipate?

The poison control center's information that coral snake venom primarily affects the nervous system should help you anticipate signs and symptoms in the patient such as blurred vision, confusion, headache, slurred speech, numbness, paralysis, and coma. These bites may be painless at first, and major symptoms may not develop for hours. That's why these patients should always be further evaluated in the emergency department even when they might describe feeling fine right after the bite.

A young man who kept a rattlesnake was handling it when it bit him on the hand. The area is swollen and discolored. When you call the poison center, the poison information specialist tells you that rattlesnake venom affects primarily the cardiovascular system. What signs and symptoms should you anticipate?

The poison control center's information that rattlesnake venom primarily affects the cardiovascular system should help you anticipate signs and symptoms you may see in the patient, such as a rapid, weak pulse; a low blood pressure; skin color changes; and weakness. These bites tend to be very painful when they first occur, and symptoms develop quickly.

What is the sequence of assessment steps in cases of poisoning?

The sequence of assessment steps in cases of poisoning is: detect and treat immediately life-threatening problems in the primary assessment, perform a history and physical exam, assess baseline vital signs, consult medical direction, and transport the patient with all containers and labels from the substance. Reassess the patient en route.

What is the phone number for poison control?

Throughout the United States, it is possible to reach a poison control center twenty-four hours a day by dialing 1-800-222-1222. This number connects you with the poison center covering the area the call is coming from.

downers

depressants, such as barbiturates, that depress the central nervous system, which are often used to bring on a more relaxed state of mind.

inhaled poisons

poisons that are breathed in.

injected poisons

poisons that are inserted through the skin, for example, by needle, snake fangs, or insect stinger.

ingested poisons

poisons that are swallowed.

absorbed poisons

poisons that are taken into the body through unbroken skin.

withdrawal

referring to alcohol or drug withdrawal in which the patient's body reacts severely when deprived of the abused substance.

uppers

stimulants such as amphetamines that affect the central nervous system to excite the user.

dilution

thinning down or weakening by mixing with something else. Ingested poisons are sometimes diluted by drinking water or milk.

volatile chemicals

vaporizing compounds, such as cleaning fluid, that are breathed in by the abuser to produce a "high."

List eight signs and symptoms associated with alcohol withdrawal:

1. Confusion and restlessness 2. Unusual behavior, to the point of demonstrating "insane" behavior 3. Hallucinations 4. Gross tremor (obvious shaking) of the hands 5. Profuse sweating 6. Seizures (common and often very serious) 7. Hypertension 8. Tachycardia

List five classifications of commonly abused drugs and substances:

1. Uppers 2. Downers 3. Narcotics 4. Hallucinogens 5. Volatile chemicals

A 15-year-old female has taken an overdose of acetaminophen. Which of the following organ systems are at the greatest risk of being harmed by this medication?

Acetaminophen is metabolized by the liver and can cause massive damage when ingested in abnormal quantities. Although the other organs might be damaged by this poison, the liver, by far, will experience the worst of the effects.

What is adsorption?

Adsorption is the process of one substance becoming attached to the surface of another.

A 60-year-old male has spilled some liquid insecticide on his shirt while pouring it into a distribution device. He complains of vertigo and notes he has thrown up. He left the area and now has removed his shirt. You should next:

Although identifying the poison will be important, you should first stop the absorption of the chemical by irrigating the exposed area. High-concentration oxygen will also likely be important, but not more important than stopping the absorption.

A 35-year-old female ingested 25 of her high blood pressure pills in an attempt at suicide. She is now semiconscious and moaning. She is pale and diaphoretic, and her vital signs are P 48, R 24, BP 80/40. You should first:

Although the patient has ingested pills and those toxins may be aided by substances such as activated charcoal or even milk, you cannot administer oral treatments or induce vomiting in a patient with altered mental status because of the risk of aspiration. You should instead administer high-concentration oxygen and initiate rapid transport.

A 45-year-old male has overdosed on heroin. You find him unconscious with obvious drug paraphernalia lying on the table next to him. He responds only to painful stimuli, and his vital signs are P 100, R 36, BP 130/80. You note clear lung sounds when you auscultate his chest. You should:

Although this patient clearly has a narcotic overdose, his respiratory rate is normal, and naloxone is only given to correct respiratory dysfunction. Positive pressure ventilations would be equally unnecessary. In this case you should first initiate transport. You should not administer activated charcoal, as heroin is not an ingested toxin.

A 50-year-old male has passed out while working on a large air-conditioning unit. Witnesses say he "just passed out." As you approach you note a strong odor of ammonia. You should:

Ammonia is a dangerous inhaled toxin that can also be absorbed through the skin. In this case you must retreat and await hazardous materials team response. Even if you were able to hold your breath, the substance can enter your body through your skin.

Key fact 7

Carefully document all information about the poisoning, interventions, and the patient's responses.

Key fact 3

Consult medical direction. As directed, administer activated charcoal or water or milk for ingested poisons.

What are the emergency care steps for ingested poisoning?

Emergency care steps for an ingested poisoning include gathering whatever information is available about the poison and contacting medical direction on the scene or en route. Administer activated charcoal as instructed by medical direction, and position the patient for vomiting. Have suction equipment readily available, and never discard vomitus until it can be inspected by the receiving facility personnel or physician.

What information must you gather in a case of poisoning before contacting medical direction?

Gather the following information about a poisoning case before contacting medical direction: -What substance was involved? -When did the exposure occur? -How much was ingested? -Over how long a period did the ingestion occur? -What interventions have the patient, family, or wellmeaning bystanders taken? -What is the patient's estimated weight? -What effects is the patient experiencing from the ingestion?

Key fact 1

In a poisoned patient, perform a primary assessment and immediately treat life-threatening problems. Ensure an open airway. Administer high-concentration oxygen if the poison was inhaled or injected.

A 25-year-old female notes that she took a "handful of pills" in an attempt to kill herself. After completing the primary assessment, which of the following questions would be most important to provide optimal care to this patient?

In the case of ingested overdoses, it is critically important to identify the specific type of medication ingested so that proper care can be initiated. For example, some medications have antidotes. Although each of the other questions is relevant, none is more important than establishing what medication was taken.

Which of the following would be an example of an injected toxin?

Injected toxins enter the body by breaking through the skin. The sting of an animal, such as a scorpion, breaks the skin to deliver the toxin. Poisons from plants and liquids are generally ingested or absorbed. Volatile chemicals are frequently inhaled as fumes.

A furnace problem has resulted in the release of carbon monoxide, and several patients are reporting illness as a result. This poison has most likely entered their bodies via:

Most commonly, carbon monoxide is an inhaled poison. It enters the body as a person inhales its fumes. Although there are some chemicals that are absorbed and release carbon monoxide as they are broken down by the body, these are far less common than the inhaled route.

Key fact 2

Next perform a secondary assessment, including baseline vital signs. Find out if the poison was ingested, inhaled, absorbed, or injected; what substance was involved; how much poison was taken in; when and over how long a period exposure took place; what interventions others have already done; and what effects the patient experienced.

An 86-year-old woman has been poisoned by carbon monoxide leaking from her malfunctioning furnace. She reports a severe headache, dizziness, and nausea. After removing her from the environment, you should next:

Oxygen is the single most important treatment for inhaled poisoning after the patient's airway is opened. In this case, high-concentration oxygen will decrease the amount of time it takes for the patient's body to rid itself of the inhaled toxin. Activated charcoal would not be indicated for an inhaled toxin. Although transport will be important, you must first administer oxygen.

Describe the expected effects of a hallucinogen:

People who abuse hallucinogens have a fast pulse rate, dilated pupils, and a flushed face. The patient often "sees" or "hears" things, has little concept of real time, and may not be aware of the true environment. Often what he says makes no sense to the listener. The user may become aggressive or be very timid.

Name four ways in which a poison can be taken into the body.

Poison can be 1. ingested, 2. inhaled, 3. absorbed, and 4. injected into the body.

Key fact 6

Reassess the patient en route.

Key fact 4

Remove the patient who has inhaled a poison from the environment, and administer high-concentration oxygen. Remove poisons from the skin by brushing them off or diluting them.

Key fact 5

Transport the patient with all containers, bottles, and labels from the substance. Reassess the patient en route. Carefully document all information about the poisoning, interventions, and the patient's responses.

narcotics

a class of drugs that affect the nervous system and change many normal body activities. Their legal use is for the relief of pain. Illicit use is to produce an intense state of relaxation.

toxin

a poisonous substance secreted by bacteria, plants, or animals.

delirium tremens (DTs)

a severe reaction that can be part of alcohol withdrawal, characterized by sweating, trembling, anxiety, and hallucinations. Severe alcohol withdrawal with the DTs can lead to death if untreated.

activated charcoal

a substance that adsorbs many poisons and prevents them from being absorbed by the body.

antidote

a substance that will neutralize the poison or its effects.

When a poison enters the body through unbroken skin, its route of entry is referred to as:

absorption. Ingested poisons are swallowed. Injected poisons break the skin to enter the body. Inhaled poisons enter through the lungs.

poison

any substance that can harm the body by altering cell structure or functions.

hallucinogens

mind-affecting or mind-altering drugs that act on the central nervous system to produce excitement and distortion of perceptions.