Nancy Caroline's Emergency Care in the Streets
A class of drugs that increase alertness and excitation (stimulants)
Something that counteracts the action of something else
Potent sedative-hypnotics historically used as sleep aids, antianxiety drugs, and as part of the regimen for seizure control
The family of sedative-hypnotics most commonly used to treat anxiety, seizures, and alcohol withdrawal
A seed that contains the poison ricin
Chemicals that are acids or alkalis; cause direct chemical injury to the tissues they contact
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
Any use of drugs that causes physical, psychological, legal, or social harm to the user or others affected by the user's behavior
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
A plant that contains cardiac glycosides used in making digitalis
The situation in which there is physical tolerance and psychological dependence on a drug or drugs
An agent that produces false perceptions in any one o. the five senses
Compounds made up principally of hydrogen and carbon atom mostly obtained from the distillation of petroleum
The cornerstone drug for treatment of bipolar disprder
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
A class of chemical found in many insecticides used in agriculture and in the home
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
A substance whose chemical action could damage structures or impair function when introduced into the body
Enhancement of the effect of one drug by another drug
The emotional state of craving a drug to maintain a feeling of well-being
Aspirin like drugs
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
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
Physiologic adaptation to the effects of a drug such that increasingly larger doses of the drug are required to achieve the same effect
The syndrome-like symptoms of a poisonous agent
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
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
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?
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?
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
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?
What is a major cause of mortality and morbidity from lead poisoning?
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?
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?
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 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?