EMT chapter 21 (Poisoning and overdose emergencies)
Terms in this set (120)
any substance that can harm the body by altering cell structure or functions
a poisonous substance secreted by bacteria, plants, or animals
most poisoning cases are how and involve who
accidental and involve children
what type of information do you need in poison cases?
1. what substance was involved?
2. when did the exposure occur?
3. how much was ingested?
4. over how long a period of time did ingestion occur?
5. what interventions has the patient, family, or bystanders taken?
6. what is patients estimated weight?
7. what effects is patient experiencing from the ingestion?
what are two most common results from poison ingestion?
nausea and vomiting
what other effects are the result of poison ingestion?
3. altered mental status
4. abdominal pain
6. chemical burns around the mouth
7. unusual breath odors
points you should evaluate upon entering the poisoning scene:
1. is the scene safe from whatever poisoned my patient?
2. is my patient at risk for airway, or vomiting?
3. do i need to consult poison control, ALS, etc.?
another type is food poisoning. what are some symptoms?
1. abdominal pain
2. nausea or vomiting
a substance that adsorbs many poisons and prevents them from being absorbed by the body
the process of one substance becoming attached to the surface of another (this is how activated charcoal works)
contraindications for activated charcoal:
1. patients who cannot swallow, obviously
2. patients with altered mental status because they might choke on activated charcoal and aspirate it into the lungs
3. patients who have ingested alkalis or acids - they should not take AC because some of the caustic material may have damaged the mouth, throat, and esophagus. AC cannot reverse damage, and in this case, it may cause more by swallowing it. Examples of the caustic substances are: oven cleaners, drain cleaners, toilet bowl cleaners, and lye.
4. patients who have accidentally swallowed gasoline while siphoning it. the patient will be couching violently and possibly aspirating gasoline, so they wouldn't be able to swallow the AC.
when a patient has ingested a poison, what should you do about ventilation?
1. avoid mouth to mouth ventilation
2. provide ventilation through a PFM or barrier device
is activated charcoal indicated in the food poisoning cases?
in most of them, No.
what is a traditional treatment for poisoning?
syrup of Ipecac. Causes vomiting in people with just one dose. When vomiting occurs, on average it removes less than 1/3 of the stomach contents. Because Ipecac is slow, it is relatively ineffective, and has the potential to make patient aspirate vomit.
activated charcoal generic name
activated charcoal trade name
SuperChar, InstaChar, Liqui-Char, and others
Indications of activated charcoal
poisoning by mouth
contraindications of activated charcoal
1. altered mental status
2. ingestion of alkali or acids, such as drain cleaner, toilet bowl cleaner, etc.
3. inability to swallow
medication form of activated charcoal
1. premixed with water to form a slurry
2. powder - which should be avoided in the field
grams of activated charcoal
premixed with water, it is 12.5 grams
dosage of activated charcoal
1. adult and children: 1g activated charcoal per kg of body weight
2. usual adult dose: 25 to 50 g
3. usual pediatric dose: 12.5 to 25 g
administration of activated charcoal:
1. contact MD
2. shake container
3. drink medication. if patient does not drink right away, it settles. stir it again before patient drinks it
4. record the name, dose, route, and time of administration of the medication
actions of activated charcoal
1. adsorbs certain poisons and prevents them from being absorbed into the body
2. not all brands of AC are the same, some adsorb more, so contact MD
side effects of AC
1. some patients have black stools
2. some patients may vomit, particularly those who have ingested poisons that cause nausea. if patient vomits, repeat the dose once.
if you give AC and patient vomits, what do you do?
repeat the dose once.
reassessment strategies after administering AC
1. be prepared for patient to vomit
2. be prepared for patient to deteriorate
thinning down or weakening by mixing with something else. Ingested poisons are sometimes diluted by drinking water or milk.
occasionally MD will give an order to dilute the poison by drinking water or milk. what is the typical adult dosage and typical child dosage?
1. adults - one to two glasses of water or milk
2. child - one-half to one full glass of water or milk
a substitute that will neutralize the poison or its effects
the steps for patient care in ingested poison cases
1. detect and treat life threatening problems.
2. perform secondary assessment. collect any fragments of ingested poison and bring it to transport with you.
3. assess baseline vitals
4. consult MD. administer AC.
5. transport patient.
6. perform reassessment en route to hospital
in poison cases for children, what are some important things to note?
1. find their weight - because, in combination with the estimated amount of poison ingested, it will help MD determine the appropriate treatment
2. always assume that the child has ingested a lethal amount of the poison. because it is usually very difficult to tell how much the child has taken in, always assume for the worst.
Naloxone generic name
naloxone trade name
indications for administering Narcan
1. suspected narcotic overdose
2. coma of unknown cause
contraindications for administering Narcan
1. patient breathing adequately and able to maintain own airway
dosage of Naloxone (Narcan)
0.4 - 2.0 mg
administration of Narcan
1. obtain MD
2. inspect patients mouth, make sure no obstructions
3. consider restraining patient before administering, in case patient becomes combative upon waking up
4. hook up atomizer with meds. insert in nose.
5. limit the amount of fluid administered at one time to 0.5mg per nostril.
6. repeat as needed with the other nostril.
7. record the name, route, dose, and time of administration of the medication
actions of Narcan:
reverses the effect of narcotics, including depressed level of consciousness and respiratory depression
side effects of Naloxone
may cause a person to go through withdrawals in patients dependent on narcotics
reassessment of patient after administering Naloxone
1. evaluate Level of consciousness
2. evaluate respiratory rate and depth frequently
3. the effects of narcan do not last as long as some narcotics, so some patients may lapse into a coma with respiratory depression
what is a common inhaled poisons?
what are other possible inhaled poisons?
1. chlorine gas, which is often found in swimming pool chemicals.
2. ammonia, which is released from household cleaners.
3. sprayed agricultural chemicals and pesticides
4. carbon dioxide, from industrial sources.
self contained breathing apparatus
what is a fact to remember about most inhaled poisons?
they can also be absorbed through the skin.
most common cause of hospitalization of overdose patients
what happens after someone takes acetaminophen?
the toxic effects of acetaminophen do not appear right away. after someone takes the drug, the liver becomes overwhelmed and is unable to detoxify the substance. over the next several hours, the liver sustains irreparable damage if nothing is done. if the antidote is given within the first 12 hours after an overdose, the patient should recover with a functioning liver.
what are the signs and symptoms of overdose of acetaminophen?
the signs and symptoms are delayed and not very specific. during the first 4 to 12 hours, the most the patient may experience is loss of appetite, nausea, and vomiting.
when does the patient really start to notice acetaminophen poising and what happens?
it may not be until a day or two until the patient starts experiencing RUQ pain and jaundice. this is when it is too late for the antidote to work.
several important aspects of prehospital assessment and management with acetaminophen poisoning:
1. suspect acetaminophen poisoning in conjunction with any other overdose
2. it may be appropriate to search medicine cabinets and garbage cans for empty pills or bottles depending on the circumstances.
3. deal with apparent threats to life first. because the effects of acetaminophen are delayed, there is time to institute treatment in the hospital.
Patient assessment for inhaled poison: what questions to ask
1. what substance was involved?
2. when did the exposure occur?
3. over how long a period did the exposure occur?
4. What interventions has anyone taken?
5. what effects is the patient experiencing from exposure?
patient assessment for inhaled poison: the bullet points to help remember what to ask and find out
1. what (substance)
2. when (did it occur?)
3. how long (a period did exposure occur?)
4. interventions (what interventions have been taken?)
5. effects (what effects is patient experiencing?)
patient care for inhaled poisons:
1. if patient is in unsafe environment, have trained people remove him so you can care for him
2. perform secondary assessment, obtain baseline vital signs
3. administer oxygen. This is the single most important treatment for inhaled poisoning after the patients airway is opened.
4. transport patient, with sample of poison, such as a wrapper or label
5. perform reassessment en route
The single most important treatment for inhaled poisoning after the patients airway is opened
one of the most commonly inhaled poisons
CO - Carbon Monoxide
what is carbon monoxide usually associated with?
motor vehicle exhaust and fire suppression
why have the number of CO poisoning cases increased?
because of the CO that can accumulate from the use of improperly vented wood-burning stoves and the use of charcoal for heating and indoor cooking areas without adequate ventilation
indications that there may be CO poisoning
wood-burning stoves, doors that lead to a garage, bedrooms above a garage, etc.
when inhaled, what does carbon monoxide do?
it prevents the normal carrying of oxygen by red blood cells. Death may occur as hypoxia becomes more severe.
the signs and symptoms of carbon monoxide poisoning are deceptive because
they can resemble the flu
signs and symptoms of carbon monoxide poisoning are
1. headaches, especially in a "band around the head"
3. breathing difficulty
6. altered mental status. in severe cases, unconsciousness may result
when should you suspect CO poisoning?
when you are treating a person with flu like symptoms who has been in an enclosed area. especially when a group of people in the same area have similar symptoms.
even though a person may feel better after being taken out of carbon monoxide environment...
it is still very important to administer 100% oxygen and transport to a hospital. oxygen is an antidote for carbon monoxide but it still takes time to wash out the CO from the patients bloodstream.
what are you likely to find in smoke inhalation poisoning?
irritated eyes (reddening, watering) eyes, and great injury to the airway because of the smoke
some signs that indicate an airway injured by smoke:
1. difficulty breathing
3. breathing that has a "smoky" smell or odor of chemicals involved on scene
4. black (carbon) residue on the persons mouth and nose
5. black residue in any sputum coughed up by patient
6. nose hairs singed from super-heated air
treatment and assessment for someone with smoke inhalation:
1. assess patient
2. administer high concentration oxygen - administer high concentration even if pulse ox reading is 100%
carboxyhemoglobin us red like oxyhemoglobin, and the two cannot be distinguished by pulse oximeters.
the body's reaction to toxic gases and foreign matter in the airway can often be...
...delayed. convince all smoke inhalation patients they need to be seen by a physician, even if they do not yet feel the serious effects.
a form of suicide that originated in Japan and is now in the US. by mixing two chemicals, usually in Japan they are toilet bowl cleaner and bath salts, it will cause the release of toxic hydrogen sulfide chemicals gas. other chemicals in the US are used, and can lead to the same result. Typically in the US these chemicals are a source of acid, like a strong household cleaner, and a source of sulfur, like a pesticide, and they will quickly release significant amounts of hydrogen sulfide gas when mixed together.
is best known for its egg odor. what is a less known fact is that even at moderate concentrations, it can be quite dangerous.
what does hydrogen sulfide do to oxygen and the body's cells?
hydrogen sulfide takes the place of oxygen. It also binds with the iron cells in the body, which prevents oxygen from binding to those cells (iron is needed for the production of hemoglobin in red blood cells, which transports blood) and getting to where it is needed.
1. Mild exposure to hydrogen sulfide can result in:
2. more severe exposure to hydrogen sulfide can result in:
3. in some severe cases,
1. mild exposure: coughing, eye irritation, and sore throat.
2. severe exposure: dizziness, nausea, shortness of breath, headache, and vomiting
3. in some severe cases, fluid will collect in the lungs, pulmonary edema, resulting in death.
absorbed poisons and the skin
they frequently irritate or damage skin. however, some poisons can be absorbed with little or no damage to the skin.
EMT precautions in absorbed poisons
just as poisons can be absorbed by patients, it can also be absorbed by the EMTs. EMTs need to make sure they take protective measures when dealing with these patients, and sometimes firefighters may have to decontaminate patients before you can touch them.
absorbed poisons patient assessment questions - what to ask
1. what substance was involved
2. when did the exposure occur
3. how much of substance was patient exposed to
4. over how long a period did exposure occur
5. what interventions has anyone taken
6. what effects is patient experiencing from exposure
absorbed poisons patient questions - bullet points on what to ask (W.W.H.H.I.E)
1. what (substance)
2. when (did it occur)
3. how much (was patient exposed to)
4. how long (did exposure occur)
5. interventions (did anyone take)
6. effects (has the patient had from exposure)
commonly seen effects from absorbed poisons
1. liquid or powder to patients skin
patient care for absorbed poisons
1. primary assessment - detect any life threats
2. secondary assessment - and vital signs
3. remove poison
4. transport - make sure to grab bottles or wrappers of poison
5. perform reassessment en route
how can you remove absorbed poison from patient?
1. powders - brush off of patient
2. liquids - irrigate with clean water for 20 minutes and continue en route if possible
3. eyes - irrigate with clean water for 20 minutes and continue en route if possible
the most important part of the treatment of a patient with an absorbed poison is
to get the poison off the skin or out of the eye
"Neutralizing" these acids or alkalis with solutions like dilute vinegar or baking soda -
- they have never been proven to help, and they can actually cause damage.
poison center controlling the area you are calling from - the phone # is
when dealing with intoxicated patients or anyone who is exhibiting irrational or potentially dangerous behavior, you should
not hesitate to call the police.
List some medical problems that can make a patient appear to be intoxicated but really may not be -
3. head injury
4. high fever
when there is a presence of alcohol or the signs and symptoms of alcohol abuse, make you sure you:
do not let that override your suspicions of other medical problems or injuries.
signs and symptoms of alcohol abuse:
1. odor on patients breath
4. face appearance
5. nausea, vomiting
7. reaction time
12. mental status
1. odor on patients breath and clothing - by itself, this is not enough proof. Also, be aware the breath is not 'acetone' breath, like in some diabetic emergencies
2. swaying and unsteadiness of movement
3. slurred speech, rambling words or phrases
4. a flushed appearance to the face
5. nausea or vomiting
6. poor coordination
7. slowed reaction time
8. blurred vision
11. lack of memory (blackout)
12. altered mental status
the patient may not necessarily be suffering from alcohol abuse, but maybe it is
referring to alcohol or drug withdrawal in which the patients body reacts severely when deprived of the abused substances
a severe reaction that can be part of alcohol withdrawal, characterized by sweating, trembling, anxiety, hallucinations.
DTs - Delirium Tremens - severe alcohol withdrawal with the DTs can lead to death if untreated
Some signs of alcohol withdrawal are:
7. blood pressure
1. confusion and restlessness
2. unusual behavior, sometimes to the point of showing insane behavior
4. obvious shaking of the hands
5. profuse sweating
all patients with ____ or ____ must be transported to a medical facility ASAP
seizures or DTs - Delirium Tremens
Patient care for alcohol abuse
1. stay on the alert for airway and respiratory problems. be prepared to suction. be prepared for patient to lose consciousness. provide oxygen and ventilations as needed.
2. assess patient for trauma due to his intoxication
3. be aware of changes in mental status. talk to patient to keep him alert
4. monitor vital signs
5. treat for shock
6. protect patient from self-injury
7. stay alert for seizures
8. transport patient
stimulants such as amphetamines that affect the central nervous system to excite the user
a patient under the influence + making decisions =
patient under the influence of alcohol cannot make an informed refusal of treatment or transport. if patient refuses, you should still treat and transport. Get PD to help if needed. Contact MD, especially before treating/transporting patient against his will.
when a chemical substance is being taken for other than medical (therapeutic) reasons
1. Many people use uppers to to:
2. examples of uppers are:
1. relieve fatigue or to create feelings of well-being.
2. caffeine, amphetamines, cocaine
can be injected, snorted, or smoked.
depressants, such as barbiturates, that depress the central nervous system, which are often used to bring on a more relaxed state of mind
examples of "downers"
this type of drug is what is used as a relaxing agent, sleeping pill, or tranquilizer.
two more common forms of "downers"
1. Rohypnol - "roofies", the "date rape" drug - colorless, odorless, and tasteless.
2. Gamma hydroxybutyrate, GHB, "Georgia Home Boy" or "Goop" - depresses CNS and produces a sense of euphoria and sometimes hallucinations. can cause mild to severe respiratory depression
a class of drugs that affect the nervous system and change many normal body activities. Their legal use is for relief of pain. Illicit use is to produce an intense state of relaxation
One common form of narcotic that is abused
other types of narcotics that are abused
3. Heroin is often injected into a vein
Narcotic overdoses are generally characterized by 3 signs:
1. coma, or depressed level of consciousness
2. pinpoint pupils
3. respiratory depression - slow, shallow respirations
the "opiate triad"
mind-affecting or mind-altering drugs that act on the Central Nervous System to produce excitement and distortion of perception
vaporizing compounds, such as cleaning fluid, that are breathed in by the abuser to produce a "high"
volatile chemicals. they give an initial rush and then act as a depressant on the central nervous system
methods of inhaling volatile substances
huffing - breathing fumes directly from a substance-impregnated fabric
bagging - breathing fumes from a substance sprayed into a bag
what substances are commonly abused as volatile substances?
cleaning fluid, glue, model cement, and correction fluids to correct ink-based errors
another type of commonly abused drug is a "designer drug", which do what?
they produce effects similar to or greater than the drugs they are based on, but because of their slight chemical differences, do not fall under the legal definition of prohibited drugs.
Commonly abused Uppers and their nicknames - a list from the chart on page 596
1. amphetamine - benzedrine, bennies, pep pills, ups, uppers, cartwheels
2. biphetamine - bam
3. cocaine - coke, snow, crack
4. desoxyn - black beauties
5. dextroamphetamine - dexies, dexedrine
6. methamphetamine - speed, meth, crystal, diet pills, methedrine
7. methylphenidate - ritalin
Commonly abused Downers - a list from the chart on page 596
Commonly abused Narcotics - a list from the chart on page 596
1. Codeine, often in cough syrup
Commonly abused Volatile Chemicals - a list from the chart on page 596
1. cleaning fluid
2. furniture polish
5. hair spray
6. nail polish remover
7. paint thinner
8. correction fluids
People who use uppers display what kind of actions?
Think of energy levels, respiratory and pulse, speech, eyes, skin, etc...
2. increased pulse and breathing
3. rapid speech
4. dry mouth
5. dilated pupils
7. complaint of not sleeping
8. restless, hyperactive
9. very apprehensive and uncooperative
people who use downers display what kind of actions?
Think of muscles, energy level, respiratory, etc...
1. sluggish and sleepy
2. lacking typical coordination of body and speech
3. pulse and breathing rates are low
people who use narcotics show what kind of actions?
Think of skin, eyes, muscles, energy level, respiratory, cardiac, etc...
1. reduced pulse and rate of breathing, lowering skin temperature
2. pupils constrict, sometimes to a pinpoint in size
3. muscles are relaxed
4. profuse sweating
5. patient is very sleepy, doesn't want to do anything
6. in overdoses, coma can develop
7. respiratory arrest or cardiac arrest may rapidly develop
people who use hallucinogens show what kind of actions?
Think of eyes, skin, effects of hallucinogens, and their actions, etc...
1. fast pulse
2. dilated pupils
3. flushed face
4. sees or hears things
5. has little concept of time or of real environment
6. may become aggressive or very timid
people who use volatile chemicals show what kind of actions?
Cardiac, odd sensations, or other problems that may develop...
1. appear dazed or show temporary loss of contact with reality
2. may develop a coma
3. may complain of funny numb or tingly feeling inside their head
4. changes in heart rhythm can occur, which can lead to death
In cases of withdrawal, you may see signs and symptoms like:
4. confusion and irritability
5. hallucinations, seeing or hearing things
6. profuse sweating
7. increased pulse and breathing
Many of the symptoms for substance use have the same symptoms as...
... medical emergencies do. Make sure you do not rule out medical emergencies when on the scene with drugs and substance abuse.
Many drug abusers at first are...
... calm at first and then get combative as time goes by.