Download Overdose - Hatzalah of Miami-Dade

Poisoning
Poisons

Substance which when introduced into
body in relatively small amounts causes in
structural damage or functional
disturbances
Suspect with:
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GI signs/symptoms (nausea, vomiting,
diarrhea, pain)
Altered LOC, seizures, unusual behavior
Pupil changes, salivation, sweating, other
signs/symptoms of disturbed autonomic
nervous system function
Respiratory depression
Burns, blisters of lips, mucous
membranes
Unusual breath odors
Treat Patient, Not Poison

Proper support of ABCs is first step
in management
Try to determine:
What?
 How much?
 How long ago?
 What has already been done?
 Psychiatric history?
 Underlying illness?

When in doubt. . .
Assume containers were full
 Entire contents were ingested

If several patients involved. . .

Assume each ingested entire
container contents
Always. . .
Bring sample of material if possible
 Save for analysis, if patient vomits
 Call poison center for advice on
management

Poisoning Management

Based on route of entry
– Ingested
– Absorbed
– Inhaled
– Injected
Ingested Poisons

Prevent absorption of toxin from GI
tract into bloodstream
– Activated charcoal
– Syrup of Ipecac
Activated Charcoal
Adsorbs toxin, prevents
absorption from GI tract
Activated Charcoal

Names
– SuperChar
– InstaChar
– Actidose
– Liqui-Char
Activated Charcoal

Form
– Premixed in water (slurry)
– Usually bottle containing 12.5 gms
Activated Charcoal

Dosage
– 1 gm/kg of patient body weight
– Usual adult dose: 25 to 50 gms
– Usual child dose: 12.5 to 25 gms
Activated Charcoal

Contraindications
– Altered mental status
– Inability to swallow
– Ingestion of acids or alkalis

Does not bind
– Alcohol
– Petroleum products
– Metals (iron)
Activated Charcoal

Side Effects
– Nausea, vomiting
– Black stools
Activated Charcoal

Administration
– Shake container thoroughly
– Use covered opaque container
– Have patient drink through straw
– If patient vomits dose may be repeated
Syrup of Ipecac
Induces vomiting by irritating
stomach and stimulating vomiting
center in brainstem
 Seldom used anymore
 May be helpful if ingestion has
occurred within last 30 minutes

Syrup of Ipecac

Dose
Children = 15 cc orally
Adults = 30 cc orally
Repeat once after 20 minutes as
needed
 Be sure patient has H20 in stomach
 Should not be given at same time as
activated charcoal

Syrup of Ipecac

Contraindications
– Decreased level of consciousness
– Seizing or has seized
– Caustic poison (acids or alkalis)
– Petroleum based products
Absorbed Poisons

Dry chemicals
– dust skin, then
– wash

Liquid chemicals
– wash with large amounts of H20
– avoid “neutralizing” agents
CAUTION
Don’t accidentally expose yourself!
Inhaled Poisons
Remove patient from exposure
 Maximize oxygenation, ventilation

CAUTION
Don’t accidentally expose yourself!
Injected Poisons

Attempt to slow absorption
Venous constricting bands
Dependent position
Splinting of injected body part
Cold packs (+) [May worsen local injury
by concentrating poison]
Drug Abuse/Overdose
Substance Abuse

Self administration of a substance in
a manner not in accord with
approved medical or social practices
Substance Abuse
Psychological dependence
 Physical dependence
 Compulsive drug use
 Tolerance
 Addiction

Psychological Dependence
Habituation
 Substance needed to support user’s
sense of well-being

Physical Dependence

Substance must be present in body
to avoid physical symptoms
(withdrawal)
Compulsive Drug Use

Use of drug and rituals/culture
associated with its use become an
overwhelming desire
Tolerance
Increasing amounts of drug needed
to produce same effects
 Tolerance contributes to addiction by
keeping user “chasing the last high”

Addiction
Combination of psychological
dependence, physical dependence,
compulsive use, and tolerance
 Patient becomes totally consumed
with obtaining, using drug to
exclusion of all other things

Ethyl Alcohol (EtOH)
Ethyl Alcohol
A CNS Depressant Drug
Decreased Reaction
Time
Increased Accidental
Trauma Risk
Decreased Social
Inhibitions
Increased Intentional
Trauma Risk
Potentiation of Other
CNS Depressants
Lethal Overdoses in
Combination with Other
Drugs
Irritation, Gastritis,
Ulcer Disease, GI
Bleeds
Respiratory
Depression, Shock
Slowed GI Tract
Activity
Toxic Overdose
Ethanol Intoxication Signs
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Breath odor
Swaying, unsteadiness
Slurred speech
Nausea, vomiting
Flushed face
Drowsiness
Violent, erratic behavior
Ethanol
Clouds signs, symptoms
 Complicates assessment
 Head trauma, diabetes, drug toxicity,
CNS infection can mimic EtOH
intoxication and vice versa

Patient is NEVER
“just drunk” until all
other possibilities are
excluded
Alcohol Addicts

Experience alcohol withdrawal syndrome
if they reduce intake:
Restlessness, tremulousness
Hallucinations
Seizures
Delirium tremens--all of above plus
tachycardia, nausea, vomiting, hypertension,
elevated body temperature
Delirium Tremens
Life threatening condition!
 Occurs 1 days to 2 weeks after intake
is decreased
 5 to 15% mortality
 Control airway, prevent aspiration,
monitor for hypovolemia

Narcotics
Opium
 Opium derivatives
 Synthetic compounds that produce
opium-like effects

Narcotics
Opium
 Heroin
 Morphine
 Demerol
 Dilaudid

Percodan
Codeine
Darvon
Talwin
Narcotics
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Medical Uses
– analgesics
– anti-diarrheal agents
– cough suppressants
Narcotics

Overdose
Coma
Respiratory depression
Constricted (pin-point) pupils
Narcotics
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Withdrawal
– Agitation
– Anxiety
– Abdominal pain
– Dilated pupils
–Sweating
–Chills
–Joint pains
–Goose flesh
Resembles severe influenza
Not a life-threat
Barbiturates
Nembutal
 Seconal
 Pentobarbital
 Amytal
 Tuinal
 Phenobarbital

Barbiturates
Induce sleepiness, state similar to
EtOH intoxication
 Medical uses

– Anesthetics
– Sedative
– Hypnotics
Barbiturates

Overdose
– Coma
– Respiratory depression
– Shock

Extremely dangerous in combination
with EtOH
Barbiturates
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Withdrawal
– Resembles EtOH withdrawal (DTs)
– Extremely dangerous
Barbiturate-like Non-barbiturates
Doriden, Placidyl, Quaalude,
Methyprylon
 Effects similar to barbiturates
 Overdose can cause sudden, very
prolonged respiratory arrest
 Withdrawal resembles ETOH;
extremely dangerous

Tranquilizers
Valium, Librium, Miltown, Equanil,
Tranxene
 Low doses relieve anxiety, produce
muscle relaxation
 High doses produce barbiturate-like
effects

Tranquilizers

Overdose:
Unlikely to cause respiratory arrest
alone
Extremely dangerous with EtOH

Withdrawal
– Resembles EtOH withdrawal
– Extremely dangerous
CNS Stimulants: Amphetamines
Dexedrine, Benzedrine, Methyl
amphetamine
 Relieve fatigue, promote euphoria,
reduce appetite

CNS Stimulants: Amphetamines
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Overdose
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Restlessness, paranoia
Tachycardia
Hypertension
CVA, Heart failure
Hyperthermia
Heat stroke
Withdrawal
– Lethargy
– Depression
CNS Stimulants: Cocaine
Stronger stimulant effects than
amphetamines
 Can cause respiratory/cardiovascular
failure, heat stroke, lethal
arrhythmias

CNS Stimulants: Cocaine
“Snorting” can destroy nasal
septum, cause massive nosebleed
 Withdrawal:

– lethargy
– depression
Hallucinogens
LSD, psilocybin, peyote, mescaline,
DMT, MDMA
 Enhance perception
 Wrong setting may induce “bad
trips” with extreme anxiety
 True toxic overdose rare

Phencyclidine
PCP, angel dust
 Produces bizarre, violent behavior
 Reduces pain sensation
 Patients may be capable of feats of
extreme strength
 Keep patient in quiet environment,
minimize stimulatin
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Solvents
Glue, paint, gas, light fluid, toluene
 Inhalation produces state similar to
EtOH intoxication
 Patient may asphyxiate if
consciousness lost while “sniffing”

Solvents
Increase risk of arrhythmias
 May cause liver damage, bone
marrow depression
 Chronic abuse causes CNS damage
- paranoia, violent behavior
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