How can we help?

You can also find more resources in our Help Center.

118 terms

Toxicology: Substance Abuse and Poisoning

Chapter 33 Nancy Caroline's Emergency Care in the Streets Sixth edition
STUDY
PLAY
A class of drugs that increase alertness and excitation (stimulants)
amphetamines
Something that counteracts the action of something else
antagonist
Potent sedative-hypnotics historically used as sleep aids, antianxiety drugs, and as part of the regimen for seizure control
barbiturates
The family of sedative-hypnotics most commonly used to treat anxiety, seizures, and alcohol withdrawal
benzodiazepines
A seed that contains the poison ricin
castor bean
Chemicals that are acids or alkalis; cause direct chemical injury to the tissues they contact
caustics
A severe withdrawal syndrome seen in people with alcoholism who are deprived of ethyl alcohol
delirium tremens (DTs)
A substance that has some therapeutic effect when given in appropriate circumstances and approproate dose
drug
Any use of drugs that causes physical, psychological, legal, or social harm to the user or others affected by the user's behavior
drug abuse
A chronic disorder characterized by the compulsive use of a substance that results in physical, psychological, or social harm to the user who continues to use the substance despite the harm
drug addiction
A plant that contains cardiac glycosides used in making digitalis
foxglove
The situation in which there is physical tolerance and psychological dependence on a drug or drugs
habituation
An agent that produces false perceptions in any one o. the five senses
hallucinogen
Compounds made up principally of hydrogen and carbon atom mostly obtained from the distillation of petroleum
hydrocarbons
The cornerstone drug for treatment of bipolar disprder
lithium
Psychiatric medication used primarily to treat atypical depression by increasing norepinephrine and serotonin levels in the CNS
Monoamine oxidase inhibitors (MAOIs)
The generic term for opioids and opiates, drugs that act as a CNS depressant and produce insensibility or stupor
narcotics
A class of chemical found in many insecticides used in agriculture and in the home
organophosphates
A physiologic state of adaptation to a drug, usually characterized by tolerance to the drug's effects and a withdrawal syndrome if use of the drug is stopped, especially abruptly
physical dependence
A substance whose chemical action could damage structures or impair function when introduced into the body
poison
Enhancement of the effect of one drug by another drug
potentiation
The emotional state of craving a drug to maintain a feeling of well-being
psychological dependence
Aspirin like drugs
salicylates
A class of antidepressants that inhibit the reuptake of serotonin
Selective serotonin reuptake inhibitors (SSRIs)
An idiosyncratic complication that occurs with antidepressant therapy in which patients have lower extremity muscle rigidity, confusion or disorientation, and/or agitation
serotonin syndrome
The act of two substances such as drugs, in which the total effects are greater than the sum of the independent effects of the two substances
synergism
Physiologic adaptation to the effects of a drug such that increasingly larger doses of the drug are required to achieve the same effect
tolerance
The syndrome-like symptoms of a poisonous agent
toxidrome
A group of drugs used to treat severe depression and manage pain; minimal dosing errors can cause toxic results
tricyclic antidepressants (TCAs)
A predictable set of signs and symptoms, usually involving altered central nervous system activity, that occurs after the abrupt cessation of a drug or after rapidly decreasing the usual dosage of a drug
withdrawal syndrome
What two general headings do toxicologic emergencies fall under?
intentional or unintentional
What are the four primary methods of entry?
ingestion, inhalation, injection, absorption
What assessment clues may point towards ingestion of a toxin or drug?
a plant with partially chewed leaves or a section of plant with berries missing, stained fingers, lips, or tongue, empty pill bottles, the date the prescription was filled and number of pills left
What are toxidromes useful for?
remembering the assessment and management of different substances that fall under the same clinical umbrella
What are signs and symptoms of stimulants?
restlessness, agitation, incessant talking, insomnia, anorexia, dilated pupils, tachycardia, tachypnea, hypertension or hypotension, paranoia, seizures, cardiac arrest
What are examples of stimulants?
amphetamine, methamphetamine, cocaine
What are signs and symptoms of narcotics (opiate and opioid)?
constricted (pin-point pupils), marked respiratory depression, needle tracks, drowsiness, stupor, coma
What are examples of narcotics (opiate and opioid)?
heroin, opium, morphine, hydromorphone (Dilaudid), fentanyl, oxycodone-aspirin combo (Percodan), Ambien
What is the most widely abused drug in the US?
alcohol
What are the two distinct phases of alcoholsim?
first phase: problem drinking
second phase: true addiction, abstinence causes major withdrawal symptoms
What are medical consequences of alcohol abuse?
chronic damage to the CNS, damage to the cerebellum which results in problems of balance, damages stomach lining, gastritis, poor clotting ability, hypoglycemia, GI bleeding,
What is the most immediate danger to an acutely intoxicated person?
respiratory depression and/or aspiration of vomitus or stomach contents to a suppressed gag reflex
What drug might medical control direct you to give for alcoholic patients?
thiamine
What is the dosage of thiamine?
100mg via slow IV push
When do DTs usually start?
48-72 hours after the last alcohol intake
What are signs and symptoms of DTs?
confusion, tremors, restlessness, fever, diaphoresis, hallucinations, hypotension often secondary to dehydration
To choose the appropriate course of action in a toxicologic emergency, what information should you obtain at the minimum?
what is the agent?
when was the agent taken?
how much was taken?
what else was taken?
has the patient vomited or aspirated?
why was the substance taken?
What does the clinical presentation of the stimulant abuser include?
excitement, delirium, tachycardia, hypertension with a fast pulse rate, dilated pupils;
As toxic levels are reached, the patient may develop psychosis, hyperpyrexia, tremors, seizures, and cardiac arrest
What is cocaine?
a local anesthetic and CNS stimulant that has the ability to create a euphoria that features enhanced alertness and a tremendous sense of well-being
What effects does cocaine have on the cardiovascular system?
lethal arrhythmias, AMI, widening of the QRS complex, QT prolongation, wide-complex arrhythmias, negative inotropic effects with decreased cardiac output, hypotension, tachycardia, bradycardia
What is the treatment for patients abusing stimulants (cocaine, amphetamine, or methamphetamine)?
maintain maximum oxygen saturation levels, prevent seizures with adequate sedation, monitor vitals, establish IV access, ECG monitoring, Haldol for violent behavior
What signs and symptoms does smoking marijuana result in?
bronchodilation, slight tachycardia, euphoria, drowsiness, decreased short-term memory, diminished motor coordination, increased appetite, bloodshot eyes
What are synthetic and naturally occuring hallucinogenics?
synthetic incude LSD, PCP, and ketamine;
naturally occurring include mescaline, psilocybin mushroom, and the seeds of the Jimson weed plant
What does LSD do to the body?
It affects the senses rather than changing physiologic functions
What are signs and symptoms of PCP?
slurred speech, staggering gait, tachycardia, hypertension, staring blankly for extended periods, horizontal nystagmus, muscle rigidity (teeth grinding), mind-body separation related hallucinations, violent outbreaks, superhuman strength
Why is there little reason to insert an IV line in a patient who is on PCP?
PCP can cause sme of the most violent and difficult behavior you will encounter in the field and there is no antagonist for PCP. You could always give Haldol is needed IM
What are signs and symptoms of Ketamine use?
mild inebriation, dreamy or erotic thoughts, inscreased sociability, nausea, difficulty moving, complaint of "entering another reality"
What are signs and symptoms of mescaline use?
feelings of increased sensitivity to sensory stimulation, flashes of color (commonly geometric patterns), dilated pupils, increased heart rate, mild hypertension, increased body temperature
What is a long-acting barbiturate that is ideal for its use in seizure control?
phenobarbital
What is the management for a patient who has overdosed on barbiturates?
airway control (usually intubation to lrotect against aspiration), oxygen, monitor ECG rhythm, establish IV access,
What are the most common clinical effects of benzodiazepine overdose?
altered mentation, drowsiness, confusion, slurred speech, ataxia, general incoordination
What is the treatment for benzodiazepine overdose?
manage airway, give oxygen, establish IV access, apply ECG monitor, consider administering flumazenil, tansport
What is the dosage of Flumazenil?
0.2mg via slow IV push up to a total of 3mg
What is the difference between opioids and opiates?
opiates are natural drugs derived from opium, opioids are non-opium derived synthetics
What are some narcotic agents?
morphine, codeine, heroin, fentanyl, oxycodone, meperidine, propoxyphene, and dextromethorphan
What are opioids primarily used for in clinical medicine?
analgesia
How do opioids exert their effects on the CNS?
by binding eith receptor sites in thr brain and other tissues
What is the classic presentation of opioid use?
euphoria, hypotension, respiratory depression, pinpoint pupils
How should you manage opioid overdose?
place an OPA, provide BVM ventilations with oxygen, establish IV access, administer Narcan 0.4-2mg IV.
What is the dosage of Narcan?
0.4-2mg IV, IM, SC, or ET (max 10mg)
What are the major classes or drugs of cardiac medications?
antiarrhythmics, beta blockers, calcium channel blockers, cardiac glycosides, angiotensin-converting enzyme inhibitors
What is the drug of choice for a beta blocker overdose?
glucagon
What are options for calcium channel blocker overdose?
calcium gluconate and calcium chloride
How do organophosphates exert their toxic effects?
at junctions (synapses) of the nerve cells of the autonomic nervous system
What are the symptoms of organophosphate poisoning?
anxiety and restlessness, headache, dizziness and confusion, tremors or seizures, dyspnea, diffuse wheezing, respiratory depression, loss of consciousness, SLUDGE
What does the SLUDGE mnemonic stand for?
salivation, lacrimation, urination, defecation, gastric upset, emesis,
What is the management for organophosphate poisoning?
decontamination and removal of patient's clothing, manage airway, suction, provide oxygen, establish IV access, administer 1.0mg Atropine IV push nd repeat every 3-5 minutes until symptom reversal, administer 1-2g of 2-PAM infused with normal saline during 5-10minutes, apply ECG monitor, transport
Why do children tend to have more severe smotoms at any given level of exposure compared with adults?
children usually have a higher metabolic rate
What are symptoms and signs of carbon monoxide?
bounding pulses, dilated pupils, pallor and cyanosis, cherry red skin color (late sign), more than one patient complaining of the same complaints in the same environment
What is the management for CO poisoning?
removal of patient, give highest concentration of oxygen
What does cyanide do in the body?
it blocks the utilization of oxygen at the cellular level
What are signs and symptoms of cyanide poisoning?
altered mental status, headache palpitations, dyspnea, unconsciousness
What is the aim of treatment for cyanide poisoning?
to displace the cyanide from the cytochrome oxidase by introducing another chemical that will "attract" the cyanide
What is the treatment for cyanide poisoning?
amyl nitrate and oxygen
What is one of the most common caustic exposures in the agricultural setting ?
ammonia
What should you not do for caustic ingestions?
dont give any "neutralizing" substances, dont induce vomiting, dont perform gastric lavage, dont give activated charcoal
What are the primary goals when dealing with a patient who has inhaled hydrocarbons?
removal from the noxious environment, giving high-concentration oxygen, prompt transport
What are some tricyclic antidepressants?
amitriptyline, imipramine (Tofranil), doxepin (Sinequan), Zonalon, nortriptyline (Aventyl, Pamelor), and desipramine (Norpramin, Pertofrane)
What are the most common signs and symptoms of a TCA overdose?
AMS, arrhythmias, dry mouth, blurred vision, dilated pupils, urinary retention, constipation, and pulmonary edema
What is the most common cause of death from TCA overdose?
cardiac arrhythmias
What is a major issue with taking MAOIs?
the potential for drug interactions
What are early signs and symptoms of MAOI overdose?
hyperactivity, arrhythmias (usually sinus tachycardia), hyperventilation, nystagmus
What are popular SSRIs?
fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft)
What are early signs and symptoms of lithium overdose?
nausea, vomiting, hand tremors, excessive thirst, slurred speech
What four body systems do exposures to metals and metalloids usually affect?
neurologic, hematologic, renal, GI
Where is 90% of lead stored once in the body?
bone
What is a major cause of mortality and morbidity from lead poisoning?
encephalopathy
What can ingestion of foxglove produce?
hyperkalemia, cardiac arrhythmias
What questions should you ask when you encounter a case of plant poisoning?
when was the plant ingested?
what, exactly did the child eat? (parts of the plant)
what signs or symptoms are they having?
What should you think when two or more people are sick at the same time at the same scene?
food poisoning or CO poisoning
What three toxins produce roughly all food-related deaths?
salmonella, listeria, toxoplasma
What dies the Hymenoptera family of insects include?
bees, wasps, hornets, yellow jackets, and ants
What does death from a Hymenoptera sting usually occur from?
anaphylaxis
What is the treatment for a Hymenoptera sting?
first, determine whether the stinger and vemom sac are still attached to the skin and if so, remove by scraping the stinger off the skin. Do not pinch it to pull it out. Then clean the wound thoroughly with soap and water or an antiseptic solution. Apply cold packs for pain relief
What is the principal treatment for a tick bite?
careful removal of the tick. Grasp it by the head and as close to the skin as possible and pull straight upward using steady gentle traction, dispose of the tick in a container of alcohol
What are the two types of spider bites that are of medical concern in the U.S?
black widow and brown recluse
What might the patient report with a spider bite?
a sudden, sharp prick followed by a cramping or numbing pain that begins at the bite area and gradually spreads
What is the classic sign of the reaction to a black widow spider bite?
extreme restlessness
What are signs and symptoms of a black widow spider bite?
excruciating pain, muscular rigidity especially in the abdomen, severe respiratory distress and dsypnea, nausea and vomiting, hypertension, hypersalivation, and paresthesias
What are signs and symptoms of a brown recluse bite?
painful, reddened area with overlying blister formation and a white surrounding area of ischemia. Over the next few days the area turns dark and becomes deeply ulcerated
What does a scorpion sting cause?
immediate pain at the sting site, followed by numbness or tingling, uncontrolled roving movements of the eyes, difficulty swallowing, slurred speech, severe agitation, nausea, vomiting, muscle twitching or spasms, blurred vision, drooling, possibly seizures
What is the initial field treatment for a scorpion bite?
focuses on pain relief with analgesics and transport
What do pit vipers include?
rattlesnakes, cottonmouths, copperheads, moccasins
What is the snake venom composed of and what does it cause?
a mix of enzymes that cause local tissue damage, hemolysis, increased permeability of the vasculature, coagulopathy, and neuromuscular dysfunction
What are signs and symptoms of pit viper bites?
fang marks, localized pain, and rapidly developing edema around the area of the bite, nausea, vomiting, dizziness or weakness, oral numbness or tingling of the mouth and tongue, tachycardia and hypotension, tachypnea, and muscle fasiculations
How should you treat a pit viper bite?
scene safety, establish and maintain the airway, give high-flow oxygen, establish IV access, keep the patient calm, supine, and motionless to decrease venom spread and absorption. Immobilize extremity with the bite in neutral position below the level of the heart, administer boluses of NS for hypotension, transport
Once signs and symptoms appear in coral snake bites, what should you suspect?
nausea and vomiting, tremors or seizures, drooling, paralysis of the face, mouth, or vocal chords, fixed dilated pupils, blurred vision, ataxia, muscle weakness, dyspnea, respiratory failure, hypotension, loss of consciousness
What does the treatment focus primarily on for marine envenomations?
wound irrigation, removal or foreign bodies (spines, teeth), pain relief, tansport