Download a01648-21-ppt 1286KB Jan 14 2015 08:21:45 AM

Copyright © 2004, Mosby Inc. All rights reserved.
Chapter 21
Poisoning and Overdoses
Slide 1
Copyright © 2004, Mosby Inc. All rights reserved.
Case History
You are dispatched to a poisoning and find a
5-year-old girl who is suspected of having
ingested a large quantity of acetaminophen
(Tylenol) tablets. The mother shows you an
empty bottle, but the child appears perfectly
normal and has normal vital signs. The child
is alert and oriented.
Slide 2
Copyright © 2004, Mosby Inc. All rights reserved.
Introduction
•
Poison
 A substance that usually
kills, injures, or impairs an
organism through its
chemical action
•
Overdose
 Drugs, taken in excess or in
combination with other
agents, to the point where
poisoning occurs
Slide 3
Copyright © 2004, Mosby Inc. All rights reserved.
Incidence
•
More than 5 million poisonings
occur each year in U.S.
 Most occur in children <5 years of
age.
•
Poisonings cause more than
10,000 deaths.
•
Other causes
 Drug abuse
 Suicide
 Animal or insect bites
Slide 4
Copyright © 2004, Mosby Inc. All rights reserved.
Poison Control Centers
•
Provide access to experts in
toxicology.
•
Staffed 24 hours a day.
•
Coordinate emergency response
 Provide advice to patients at home
 Refer people to area hospitals with
poisoning care capabilities
 Advise EMTs, physicians, and
nurses
Slide 5
Copyright © 2004, Mosby Inc. All rights reserved.
Types of Poisonings
•
Ingested
•
Injected
•
Inhaled
•
Absorbed
Slide 6
Copyright © 2004, Mosby Inc. All rights reserved.
Cardinal Rules
•
Treat the patient, not
poison.
•
Protect self and
bystanders.
•
Look for clues of trauma.
•
Maintain a high level of
suspicion.
Slide 7
Copyright © 2004, Mosby Inc. All rights reserved.
Scene Size-up
•
Survey the scene to protect
yourself and bystanders.
•
Dangers
 Toxic gases
 Absorbed toxins
•
Do not enter without adequate
protection.
 Only trained hazmat rescuers
should enter.
Slide 8
Copyright © 2004, Mosby Inc. All rights reserved.
Initial Assessment
•
What is your general
impression?
•
Findings indicate any trauma?
•
Is the patient awake and
responsive?
•
Airway, Breathing, Circulation
Slide 9
Copyright © 2004, Mosby Inc. All rights reserved.
Focused History
•
What is the poison?
•
How was it taken?
 Was it ingested, inhaled, absorbed, or injected?
•
When was it taken?
•
How much was taken?
•
Over what period of time?
Slide 10
Copyright © 2004, Mosby Inc. All rights reserved.
Focused History
•
Is there any other evidence at the scene (e.g.,
commercial products, pills)?
•
Were any other interventions attempted?
 Vomiting
 Dilution
 Activated charcoal
 Syrup of ipecac
 Antidote
•
How much does the patient weigh?
Slide 11
Copyright © 2004, Mosby Inc. All rights reserved.
Perform a
Focused Physical Examination
•
•
•
Skin
Pupils
Breath sounds
•
•
•
Abdomen
Mental status
Vital signs
Slide 12
Copyright © 2004, Mosby Inc. All rights reserved.
Emergency Medical Care
•
Remove patient from poisonous environment.
•
Ensure patent airway and administer oxygen.
•
Be alert for vomiting.
•
Bring all poison agents to hospital.
 Containers
 Bottles
 Labels
Slide 13
Copyright © 2004, Mosby Inc. All rights reserved.
Ingested Poisons –
Signs and Symptoms
•
•
•
•
History of ingestion
Nausea
Vomiting
Diarrhea
Slide 14
Copyright © 2004, Mosby Inc. All rights reserved.
Ingested Poisons –
Signs and Symptoms
•
Altered mental status
•
Abdominal pain
•
Chemical burns around
the mouth
•
Different breath odors
Slide 15
Copyright © 2004, Mosby Inc. All rights reserved.
Odors
Smell
Possible Poison
Acetone (sweet, fruity)
Ethanol, isopropyl
alcohol, diabetic
Alcohol
Alcohol, isopropyl
alcohol
Disinfectants
Creosol and phenol
Rotten eggs
Hydrogen sulfide
Garlic
Insecticides
Stale tobacco
Nicotine
Wintergreen
Methyl salicylate
Slide 16
Copyright © 2004, Mosby Inc. All rights reserved.
Emergency Medical Care
•
Remove poison from patient’s
mouth using gloves.
•
Consult medical direction.
 Activated charcoal
•
Bring all containers (bottles,
labels, etc.,) to hospital.
Slide 17
Copyright © 2004, Mosby Inc. All rights reserved.
Types of Ingestions
•
Sedative-hypnotics
•
Antianxiety agents
•
Opioids
•
Psychiatric medications
•
Stimulants
Slide 18
Copyright © 2004, Mosby Inc. All rights reserved.
Types of Ingestions –
Sedative-Hypnotics
•
Barbiturates
 Secobarbital (Seconal)
 Pentobarbital (Nembutal)
•
Benzodiazepines
 Diazepam (Valium)
 Chlordiazepoxide (Librium)
 Chlorazepate (Tranxene)
Slide 19
Copyright © 2004, Mosby Inc. All rights reserved.
Types of Ingestions –
Sedative-Hypnotics
•
Others




Methaqualone (Quaalude)
Ethchlorvynol (Placidyl)
Chloral hydrate (Noctec)
Mebrobamate (Miltown)
Slide 20
Copyright © 2004, Mosby Inc. All rights reserved.
Toxic Effects –
Sedative-Hypnotics
•
Altered mental status
•
Respiratory depression
and arrest
•
Most toxic when
combined with alcohol
•
Support of ABCs is
critical.
Slide 21
Copyright © 2004, Mosby Inc. All rights reserved.
Types of Ingestions
Opioids (Narcotics)
•
Central nervous system depressant
 Examples
» Heroin
» Morphine
» Percocet
» Percodan
Slide 22
Copyright © 2004, Mosby Inc. All rights reserved.
Toxic Effects/Management –
Opioids (Narcotics)
•
Toxic effects and signs and
symptoms




•
Altered (depressed) mental status
Respiratory depression
Pinpoint pupils
Track marks
Management
 Support ABCs
 Administration of naloxone (Narcan) by
ALS providers or hospital
Slide 23
Copyright © 2004, Mosby Inc. All rights reserved.
Ingested Substances
•
Stimulants
 Cause increased
excitability (e.g.,
amphetamines)
•
Alcohol
•
Heart and lung drugs
•
Analgesics
Slide 24
Copyright © 2004, Mosby Inc. All rights reserved.
Inhaled Poisons –
Signs and Symptoms
•
History of inhalation of
toxic substance
•
Dizziness
•
Headache
•
Confusion
•
Difficulty breathing
•
Chest pain
•
Cough
•
Seizures
•
Hoarseness
•
Altered mental status
Slide 25
Copyright © 2004, Mosby Inc. All rights reserved.
Poisonous Gases
•
Simple asphyxiants
•
Carbon dioxide
•
Small hydrocarbon molecules
•
Chemical asphyxiants
•
Irritant gases
•
Organophosphates
Slide 26
Copyright © 2004, Mosby Inc. All rights reserved.
Toxic Injection –
Signs and Symptoms
•
Weakness
•
Dizziness
•
Chills
•
Fever
•
Nausea
•
Vomiting
Slide 27
Copyright © 2004, Mosby Inc. All rights reserved.
Absorbed Poisons –
Signs and Symptoms
•
History of exposure
•
Liquid or powder on patient’s skin
•
Burns
•
Itching
•
Irritation
•
Redness
Slide 28
Copyright © 2004, Mosby Inc. All rights reserved.
Emergency Medical Care
•
Skin
 Remove contaminated clothing.
 Protect self from contamination.
•
Powder
 Brush powder off patient.
 Irrigate for at least 20 minutes.
 Continue en route to facility, if possible .
•
Liquid
 Irrigate for at least 20 minutes.
 Continue en route to facility, if possible.
Slide 29
Copyright © 2004, Mosby Inc. All rights reserved.
Medication Name
•
Generic
 Activated charcoal
•
Trade
 SuperChar™
 InstaChar™
 Actidose™
 LiquiChar™
Slide 30
Copyright © 2004, Mosby Inc. All rights reserved.
Activated Charcoal
•
Indications
 Poisoning by mouth
•
Contraindications
 Altered mental status
 Ingestion of acids or alkalis
 Inability to swallow
Slide 31
Copyright © 2004, Mosby Inc. All rights reserved.
Medication Form
•
Medication is pre-mixed in water.
 Plastic bottle containing 125 grams activated
charcoal
•
Powder should be avoided in field.
Slide 32
Copyright © 2004, Mosby Inc. All rights reserved.
Dosage
•
Adults and children
 1 gram activated charcoal/kg of body weight
•
Usual adult dose
 25 - 50 grams
•
Usual infant/child dose
 12.5 - 25 grams
Slide 33
Copyright © 2004, Mosby Inc. All rights reserved.
Actions
•
Charcoal binds to certain poisons.
•
Binding action prevents absorption.
•
Not all brands are the same.
 Some bind much more poison
 Consult medical direction about the brand to use.
Slide 34
Copyright © 2004, Mosby Inc. All rights reserved.
Side Effects
•
Black stool
•
Some patients may vomit.
 If the patient vomits, repeat dose one time.
•
Reassessment strategies
 Prepare for vomiting and deterioration of patient’s
condition.
Slide 35
Copyright © 2004, Mosby Inc. All rights reserved.