Download Poisoning and Overdoses

Poisoning and Overdose
Emergencies
Topic Overview
• Emergency Medical Care of Poisoning /
Overdose
• Relationship to Airway Management
Poisoning and Overdoses
Poisonings
– There were over 2,500,000 reported
poisonings reported in 1993
• Poison
– Any substance that can harm the body
– Can also involve living organisms that
produce toxins
Poisoning and Overdoses
• Ingested- This can include household
and industrial chemicals, medications,
improperly prepared foods, plant
materials, petroleum products, and
agricultural products
• NOTE: Extreme care must be taken
when ventilating a patient that has
ingested any substance. Practice BSI!
Poisoning and Overdoses
• Inhaled
– Carbon monoxide, ammonia, chlorine,
insect sprays, and gases produced by
volatile chemicals
• Absorbed
– Usually through unbroken skin. Many
corrosives and irritants can be absorbed
after causing the skin to breakdown
Poisoning and Overdoses
• Injected- The most common is illicit
drugs but can include snakes fangs and
insects stingers
Poisoning and Overdoses
Patient Assessment-Ingested Poisons
– What was the substance?
• Get exact name
• Bring container
– When did the exposure occur?
– How much was ingested?
• If not known, estimate possible amount
Poisoning / Overdoses
– Over how long a period did the ingestion
take place?
• If not known, estimate shortest and longest
possible times
– What interventions taken?
– What is the patients estimated weight?
– Is the patient experiencing any effects from
the ingestion?
Poisoning / Overdoses
• Ingested Poisons
– Signs and Symptoms
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Altered mental status
Abdominal pain
Chemical burns around mouth
Unusual breath odor
History of ingestion
Nausea / Vomiting
Diarrhea
Poisoning and Overdoses
Treatment for Ingested Poisons
– ABCs- Correct any life-threatening
problems
– Call Poison Center 1-800-POISON1
– 1-800-764-7661
– Follow directions given by poison control
• Activated Charcoal
– It is designed to absorb large amounts
– Does not work on all poisons
Poisoning / Overdoses
• Trade Names: SuperChar, InstaChar,
LiquiChar
Activated Charcoal
• Indications
– Poisoning by mouth
• Contraindications
– Altered mental status
– Ingestion of acid or alkali
– Patient unable to swallow
• Follow directions of Poison Control
Center
Poisoning and Overdoses
Treatment- (Cont.)
– Check head, neck, chest and abdomen
– SAMPLE history
– Baseline vital signs
– Transport any containers or bottles from
the substance
– On-going assessment
Poisoning and Overdoses
Pediatric Poisonings
– Are frequent victims
– Very important to have the weight of the
patient
– Always assume a lethal dose has been
ingested
Poisons / Overdoses
• Inhaled Poisons
– General Signs and Symptoms
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History of inhalation
Difficulty speaking
Chest pain
Cough
Hoarseness
Dizziness
Headache / Confusion
Seizures
Altered Mental Status
Poisoning and Overdoses
Patient Assessment- Inhaled Poisons
– What substance?
– When did the exposure occur?
– Over how long a period was the exposure?
– Any interventions?
– What effects have been noted?
Poisoning and Overdoses
Treatment - Inhaled Poisons
– ABCs- Correct any life-threatening
problems
– Call Poison Center 1-800-POISON1
– 1-800-764-7661
– Follow directions given by poison control
ABCs- Correct any life-threatening
Poisoning and Overdoses
• Treatment
– Check head, neck, chest and abdomen
– SAMPLE history
– Baseline vital signs
– On-going assessment
Poisoning and Overdoses
• Inhaled Poisons
– Carbon Monoxide
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Most common inhaled poison
Vehicle exhaust and fire suppression
Odor-less and color-less
Signs & Symptoms
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Headache
Dizziness
Dyspnea
Cyanosis
Altered Mental Status
Poisoning and Overdoses
– Smoke Inhalation
– S and S
• Shortness of Breath
– Coughing
– Smoky breath odor
– Carbon residue around mouth and nose
– Black residue in sputum
– Nose hairs signed
Poisoning and Overdoses
• Absorbed Poisons
– Signs and Symptoms
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History of exposure
Liquid or powder on skin
Burns
Itching, irritation, redness
Poisoning and Overdoses
Patient Assessment- Absorbed
Poisons
– What substance?
– When did the exposure occur?
– Over how long a period of time?
– Any interventions?
– What effects?
Poisoning and Overdoses
• Care – Absorbed Poisons
– Remove patient from source
– Remove clothing or substance from the
patient which might be contaminated
– Brush powders from patient
– Irrigate with water for at least 20 minutes
– Initial Assessment
– SAMPLE History
Poisoning and Overdoses
• Care – Absorbed Poisons
– Eye
• Irrigate with clean water for at least 20 minutes
or until EMS arrives
Poisoning and Overdoses
• GENERAL SAFETY For Inhaled and/or
Absorbed Poisons
– Need to know wind direction and speed
– Park Uphill and Upwind of the incident
Poisons / Overdoses
• Relationship to Airway Management
– When treating a poisoned or overdoses
patient whose airway is patent, be
prepared for deterioration and need to
secure airway
Poisoning and Overdoses
Alcohol Abuse (ETOH)
– Can be a real problem to assess
– May require police assistance
– Patient often has multiple problems in
addition to the abuse of alcohol
Poisoning and Overdoses
Patient Assessment
– Odor of alcohol on the patient’s breath
– Swaying and unsteady gait
– Slurred speech, rambling, incoherent
words
– Flushed appearance to the face
– Poor coordination
Poisoning and Overdoses
Patient Assessment
– Slowed reaction time
– Blurred vision
– Confusion
– Hallucinations
– Blackouts
– Altered LOC
Poisoning and Overdoses
Signs & Symptoms of ETOH Withdrawal (DTs)
– Confusion and restlessness
– Unusual behavior
– Hallucinations
– Gross tremors
– Profuse sweating
– Seizures
– Watch for vital signs changes ETOH abuser
often mix with recreational drugs
Poisoning and Overdoses
Patient Care for ETOH Abuse
– Watch for respiratory problems
– Watch for altered LOC
– Vital signs
– Treat for shock
– Protect the patient from self-injury
– Watch for seizures
– Activate EMS
Poisoning and Overdoses
• Do Not Assume That All Patients You
Suspect Of ETOH Abuse Do Not Have
Any Underlying Medical Condition
– Many persons are arrested for DWI and
later found to be a diabetic with low blood
sugar
• Do a good patient assessment
Poisoning and Overdoses
Substance Abuse
– Stimulants
• Amphetamines, Uppers, Cocaine,
Methamphetamine
– Depressants
• Barbiturates, Downers, Valium, Heroin,
Morphine, Codeine, Inhalants, Alcohol
– Psychedelics (Hallucinogens)
• LSD, PCP, Mescaline, Cannabis
Poisoning and Overdoses
Patient Assessment- Substance Abuse
• Stimulants
– Excitement, increased alertness, euphoria
– Increased pulse and breathing
– Restlessness, irritability, Insomnia
– Rapid Speech
– Dry mouth
– Dilated Pupils
– Decreased appetite
Poisoning and Overdoses
Patient Assessment- Substance Abuse
• Depressants
– Relaxation, decreased awareness
– Drowsiness
– Slowing pulse and respirations
– Impaired coordination
– Slurred speech
– Stupor, death
Poisoning and Overdoses
Patient Assessment-Substance Abuse
• Hallucinogens
– Breakdown of Inhibitions
– Alteration of perceptions (hallucinations)
• Visual and Auditory - Bugs crawling on the wall
– Increased appetite
– Rapid Pulse, Dilated Pupils, Flushed Face
– Tremors, Death
Poisoning and Overdoses
Patient Care- Substance Abuse
– Initial Assessment
– Watch for airway problems
– Treat for shock
– Try to gain the patient’s confidence
– Perform a rapid trauma assessment
– Check for track marks
Poisoning and Overdoses
Patient Care- Substance Abuse
– Protect the patient from self-injury
– Transport ASAP and contract medical
control
– On-going Assessment
Poisoning and Overdoses
ALWAYS CLOSELY MOINTER
SUBSTANCE ABUSE PATIENTS FOR
CHANGES IN CONDITION AND FOR
TENDENCY TO BECOME VIOLENT
Bites and Stings
• Assessment – Signs and Symptoms
– History of spider / snake bite / insect /
scorpion / marine animal sting
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Pain, redness, swelling
Dizziness and chills
Fever
Nausea and vomiting
Bite marks or stinger
Bites and Stings
• Bites and Stings
– Emergency Care
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Wash area gently
Remove jewelry distal to affected area
Position injection site slightly below heart
Observe for allergic reaction
Snakes, Spiders, Scorpions
• Review information from Tri 5 Phar/Tox
• To review go to Basic Sciences,
Pharmacology/Toxicology, Dr. Giggleman’s
lecture notes on Spiders and Snakes.
Ticks
• Tick Removal
– Using forceps grasp tick at apex of thorax
(toward the head) and apply gently
backward pressure until the tick releases.
Remove the tick.
– Scrub area vigorously with soap and water
– Watch for signs of infection
Marine Life
Injuries
Marine Life Injuries
• Specific Injuries - Stingray
Envenomations
– Rinse wound vigorously with fresh water
– Immerse in nonscalding hot water to
tolerance (110-113oF or 43.3-45oC) for 3090 minutes to reduce pain. Repeat if pain
recurs.
– Remove any visible pieces of the stinger or
sheath. Scrub with soap and water, irrigate
vigorously with fresh water
– Do not tape wound, watch for infection
Marine Life Injuries
• Specific Injuries - Sea Urchin Punctures
– Immerse punctured area in nonscalding hot
water (same as for stingray injury)
– Remove any visible pieces of the spine(s)
– Purple or black discoloration of the skin does
not necessarily mean that a spine is present
– Scrub with soap and water
– Do Not crush a spine in the skin
– If a spine has penetrated into or near a joint it
may need to be removed surgically
Marine Life Injuries
• Specific Injuries - Jellyfish Stings (including manof-war, box-jelly, sea nettle, Irukandji, anemone,
hydroid)
– Immediately rinse skin in sea water (DO NOT
rinse with fresh water. Do NOT apply ice. DO
NOT rub the skin.)
– Apply soaks of acetic acid 5% (vinegar) until
pain is relieved. If acetic acid is not available
use isopropyl alcohol, dilute (1/4 strength)
ammonia, a paste of baking soda, a paste of
unseasoned meat tenderizer, or mashed
papaya.
Marine Life Injuries
• Specific Injuries - Jellyfish Stings
• Do Not apply aftershave, liquor, or organic
solvents such as kerosene, turpentine or gas
– Remove large tentacle fragments using
forceps
– Reapply vinegar
– Soap affected area in nonscalding hot
water (same as for stingray sting)
Marine Life Injuries
• Coral Cuts
– Irrigate with cleanest water available
– Scrub vigorously with soap and water
– Flush wound with 1/2 strength solution of
hydrogen peroxide in water
– Use topical antibiotic if infection develops
– Use anti-itch cream if itching develops
Marine Life Injuries
• Scorpion Fish, Stone Fish, Lion Fish
– Envenomations
– Immerse in non-scalding hot water to
tolerance (110-113oF or 43.3-45oC) for 3090 minutes to reduce pain. Repeat if pain
recurs.
– Keep extremity lower than heart level
– Avoid excessive movement
– Seek medical attention
Marine Life Injuries
• Bites
– Control bleeding and attend to other lifethreatening problems
– Treat as you would any open soft tissue
injury.
– Seek medical attention as indicated.