EM Chapter 21 Poisoning and Overdose Emergencies
Terms in this set (44)
poisons that are taken into the body through unbroken skin
substance that absorbs many poisons and prevents them from being absorbed by the body
substance that will neutralize the poison or its effects
delirium tremens (DTs)
severe reaction that can be part of alcohol withdraw, characterized by sweating, trembling, anxiety, and hallucinations; severe alcohol withdrawal with the DTs can lead to death if untreated
thinning down or weakening by mixing with something else; ingested poisons are sometimes diluted by drinking water or milk
depressants, such as barbiturates, that depress the central nervous system, which are often used to bring on a more relaxed state of mind
mind-affecting or mind-altering drugs that act on the CNS to produce excitement and distortion of perceptions
poisons that are swallowed
poisons that are breathed in
poisons that are inserted through the skin, for example, by needle, snake fangs, or insect stinger
class of drugs that affect the nervous system and change many normal body activities; legal use is for relief of pain; illicit use is to produce an intense state of relaxation
substance that can harm the body by altering cell structure or functions
poisonous substance secreted by bacteria, plants, or animals
stimulants such as amphetamines that affect the central nervous system to excite the user
vaporizing compounds, such as cleaning fluid, that are breathed in by the abuser to produce a "high"
referring to alcohol or drug withdrawal in which the patient's body reacts severely when deprived of the abused substance
While you are managing your patient's airway, a family member tells you that the patient regularly takes pills for severe back pain. Given that your patient presents with signs and symptoms of overdose, your patient most likely overdosed on:
prescription narcotic; Narcotic medications are legally prescribed to control acute or chronic pain. Users may intentionally or unintentionally overdose on these medications, causing an altered level of consciousness and depressed respiratory drive.
An antidote is:
a substance that will neutralize the effects of the poison or toxic substance.
What is the most common route of accidental poisoning in pediatric patients?
You face a situation in which a victim of chlorine gas poisoning is still conscious but lying on the ground, and the area surrounding him is contaminated with chlorine gas. What would be your BEST course of action?
Summon specially trained personnel wearing appropriate protective gear to rescue the victim while you try to coax the patient out of the contaminated area.; Making any attempt at rescue without proper training and equipment is ill advised.
If a husband and wife are both unconscious in their home and there is no outward evidence of a safety threat, which of the following possible causes should be foremost in your mind?
carbon monoxide poisoning;
Difficulty breathing, coughing, and carbon residue in the mouth are signs of:
For a patient with a known ingestion of an acid substance, you should immediately:
contact medical control or a poison control center; When a patient has ingested an acid substance, it is important to consult with medical command or poison control.
You have just arrived at the scene of a patient who has reportedly ingested an unknown chemical at an industrial site. You find the patient to be unconscious and not breathing. Recognizing the importance of the absence of breathing, you should immediately:
Ventilate the patient using a bag-valve mask while ensuring the airway is clear and patent; he safest and most appropriate approach is the use of a BVM with oxygen.
A patient who is exhibiting hallucinations, gross tremors, confusion, restlessness, hypertension, and tachycardia may be suffering from:
delirium tremens; The signs and symptoms suggest withdrawal from alcohol.
Alcohol, narcotics, and other CNS depressants can easily cause:
slow or absent respiratory rates or decreased inspiratory volume.; CNS depressants will often cause respiratory depression.
Track marks on your patient's arms suggest a history of:
IV drug abuse
You are called to the scene of a 21-year-old female patient who is unresponsive. Her boyfriend suspects that she tried to commit suicide by overdosing on her depression medications. The patient is unresponsive to painful stimuli, with agonal respirations, and has vomited. She has a weak carotid pulse. After securing the airway and providing oxygen by bag-valve mask, what is the MOST important question the EMT can ask regarding the medication?
What medication did she take?
Which of the following describes any substance produced by a living organism that is poisonous to human beings?
You are caring for a 29-year-old female patient who is unconscious and has reportedly overdosed on heroin. Which of the following physical findings is MOST likely to be found?
How does carbon monoxide cause toxic effects?
Prevents red blood cells from carrying oxygen
all things are poison - any substance that can harm body (harm = medical emergency)
common: medications (PORCH: prescription, over the counter, recreational, compliance, herbal/supplemental), petroleum products, cosmetics, pesticides, plants, food
severity: based on nature of poison, concentration, route of entry, duration of exposure, age, health, weight; local vs systematic effects; damage to skin and tissues from contact; suffocation
Mr. Yuk - 1971 Pittsburgh - prevent kids from ingesting; teach in school not to touch things with that sticker
Classified by route of entry:
inhaled (breathed in)
absorbed (through unbroken skin)
injected (inserted through skin)
Classification by toxidromes: anticholinergic (block parasympathetic activity) - HR and BP inc, RR none, temp, pupils inc; bowels, diapheresis dec; cholinergic (enhance parasympathetic activity); hallucinogenic; opiate; sedative/hypnotic; sympathomimetic
(just be aware there is a classification system)
child - accidentally eat or drink toxic substance
adult - accidental or deliberate medication overdose
manchausen syndrome vs manchausen by proxy - deliberately do to self for attention or fake symptoms
pica -> abnormal cravings for non-normal things (ex: chalk; often during pregnancy)
substance involved? when did exposure occur? child could be unconscious; how much ingested? (overdoses in medication); threshold for medication?
interventions taken? estimated weight? effects experienced? - upset stomach, vomiting, mental status, pain, burns around mouth, odors
child can get into anything; importance of public education on issue
absorption - allows substance to attach to surface
NOT AN ANTIDOTE - reduces amount absorbed
must call medical control/poison control
25-50g adult; 12.5-25 for child; if vomit stop; can reinjure esophagus
hazardous materials!: carbon monoxide, ammonia, chlorine gas, agricultural chemicals and pesticides; carbon dioxide; fozgure gas - from burned fridges - killing patients
scene safety! - call for resources if not trained
signs: difficulty breathing, chest pain, coughing, hoarseness, dizziness, headache, confusion, altered mental status, seizures; substance involved? exposure occur? how long? interventions? effects?
move from unsafe environment; life threats? open airway; oxygen
colorless, odorless, tasteless gas created by combustion; improper venting; common cause during winter months of death
headache - band around head, dizziness/nausea, breathing difficulty, cyanosis/flushing, altered mental status
multiple patients in confined area
need to find source of CO leak
CO Monitor -> Rad-57??
treatment: remove from area, 100% oxygen, transport, washout CO takes time; ideal = hyperbaric chambers
from burning materials = poisonous and toxic; irritate skin, eyes, lungs, respiratory and cardiac arrest; a lot of things involved in building houses release toxins (great -_-)
signs: difficulty breathing, coughing, smoky chemical smell on breath, black residue in mouth, nose; singed nasal or facial hair - can inspect lung injury
treatment: safe area, maintain airway, oxygen, monitor closely for swelling of airway
started in Japan - now more common in US; bleach and hydrogen sulfide = ammonia gas; toxic hydrogen sulfide gas; released in enclosed space like car; burns lungs inside out; can injury EMS; may have warning note on car but not always;
through skin; can cause damage to skin; require decontamination prior to treatment
not nearly as common
why ERs have outside showers
treatment: life-threats, history, phys exam, remove power (brush off, irrigate with clean water for at least 20 min and transport); with all containers, bottles, etc; reassess
POISON CONTROL = always a resource; information on poisons; follow local protocols
Alcohol and Substance Abuse
conditions are caused either directly or indirectly by alcohol or substance abuse - crosses all geographic and economic boundaries
drugs affects CNS; depressant; addictive; recent consumption or years of abuse; serious if combined with drugs; uncooperative or combative (difficult); everyone is different or can change
some medical conditions mimic alcohol intox: hypoglycemia; stroke; postisctal
signs: odor, swaying, slurred, rambling speech, flushed, warm, nausea/vomiting, poor coordination, slowed reaction time, blurred vision, confusion, hallucinations, lack of memory, altered mental status
alcohol withdrawal: abrupt cessation of drinking - suffer delirium tremens (DTs) - tremors, hallucinations, seizures, can be fatal;
signs: confusion, restlessness, unusual behavior (insane), hallucinations, gross tremor of hands, profuse sweating, seizures, hypertension, tachycardia
may have another condition that mimics intox - all should receive full treatment
care: vomit concern, suction, airway/respiratory problems, mental status changes, recovery position, seizures common
chemical substance taken for other than therapeutic (medical) reasons
uppers, downers, narcotics, hallucinogens, volatile chemicals, (illicit drugs, prescriptions, etc.)
Uppers: stimulants that affect nervous system - cocaine, amphetamines, snorted, smoked, injected - can cause heart attack, often after 1st time taking - inc in heart rate too much; signs: excitement, restless, increased pulse and breathing rates, sweating, hyperthermia (inc metabolism and body temp), esp if skinny - can't keep fat, no sleep for long time; significant anxiety increase; can cause early heart attacks (even if taken years before)
Downers: CNS depressants, barbiturates, roofies (rohypnol), GHB (gamma hydroxybutyrate); sluggishness, poor coordination, decreased pulse and respirations; often those who have sleep disorders and self-medicate
Narcotics: relive pain or help with sleep; opiates (heroin, codeine, morephine); oxycontin (oxycodone); injected; crushed/snorted; ingested; KNOW HOW THEY TOOK; - narcane will run up; signs: reduced rate of pulse and rate/depth of breathing; lethargy (sleepy), pinpoint pupils; profuse sweating; coma; respiratory depression
Hallucinogens: intense state of excitement and distorted perception; bad batch of ecstasy - lot of people go down; LSD, PCP, XTC (bath salts); signs: rapid pulse, dilated pupils, flushed face, seeing or hearing things
Volatile chemicals: produce vapors that are inhaled, initial "rush" can act as CNS depressant; ex: paint, aerosal cans, "huffing"; gov put bitterant in cans to stop but still do - 30sec high - deprives brain of oxygen = BAD; end up traumatic case bc injure themselves; signs: dazed/disoriented - seconds, develop coma, swollen membranes in nose/mouth, funny numb feeling, tingling inside head, changes in heart rhythm (fast, slow, normal); residue near mouth
Assessment of substance abuse patients: may be difficult (consciousness, type of drug); uncooperative, contaminated needles/chemicals present; might give something to knock them out; AIRWAY; oxygen; shock; calm and cooperative; want breathing on own and slightly out of it; narcane can sometimes have destructive and violent results; track marks; transport; local protocols;
excited delirium: occur with some medications/drugs -> bath salts; same release after working out - stuck in endless loop with superhuman strength - eventually burst- heart attack? call ALS to knock them out
pay attention to scene
notice actions, behaviors, track marks
call poison control first then medical control with what they said
transport with everything you can find
poisons classified by route of exposure
determining drug can help determine effects to come
pesticide spilled powder on hands
stimulate parasympathetic, very bradycardic, salivate like crazy - look rabid
call for hazmat team to be hosed down