poisoning and overdose emergencies. topic overview emergency medical care of poisoning / overdose...

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!


• 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


• 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?


• Ingested Poisons– Signs and Symptoms

• Altered mental status• Abdominal pain• Chemical burns around mouth• Unusual breath odor• History of ingestion• Nausea / Vomiting• Diarrhea


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


• 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


Treatment- (Cont.)– Check head, neck, chest and abdomen– SAMPLE history– Baseline vital signs– Transport any containers or bottles from

the substance– On-going assessment


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• History of inhalation• Difficulty speaking• Chest pain• Cough• Hoarseness• Dizziness• Headache / Confusion• Seizures• Altered Mental Status

Poisoning and OverdosesPatient 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?


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


• Treatment– Check head, neck, chest and abdomen– SAMPLE history– Baseline vital signs– On-going assessment


• Inhaled Poisons– Carbon Monoxide

• Most common inhaled poison• Vehicle exhaust and fire suppression• Odor-less and color-less• Signs & Symptoms

– Headache– Dizziness– Dyspnea– Cyanosis– Altered Mental Status


– 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


• Absorbed Poisons– Signs and Symptoms

• History of exposure• Liquid or powder on skin• Burns• Itching, irritation, redness


Patient Assessment- Absorbed Poisons– What substance?– When did the exposure occur?– Over how long a period of time?– Any interventions?– What effects?


• 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


• Care – Absorbed Poisons– Eye

• Irrigate with clean water for at least 20 minutes or until EMS arrives


• 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


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


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


Patient Assessment– Slowed reaction time– Blurred vision– Confusion– Hallucinations– Blackouts– Altered LOC


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


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


• 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


Substance Abuse– Stimulants

• Amphetamines, Uppers, Cocaine, Methamphetamine

– Depressants• Barbiturates, Downers, Valium, Heroin,

Morphine, Codeine, Inhalants, Alcohol

– Psychedelics (Hallucinogens)• LSD, PCP, Mescaline, Cannabis


Patient Assessment- Substance Abuse

• Stimulants– Excitement, increased alertness, euphoria– Increased pulse and breathing– Restlessness, irritability, Insomnia– Rapid Speech– Dry mouth– Dilated Pupils– Decreased appetite


Patient Assessment- Substance Abuse• Depressants

– Relaxation, decreased awareness– Drowsiness– Slowing pulse and respirations– Impaired coordination– Slurred speech– Stupor, death


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


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


Patient Care- Substance Abuse – Protect the patient from self-injury– Transport ASAP and contract medical

control– On-going Assessment


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

• Pain, redness, swelling• Dizziness and chills• Fever• Nausea and vomiting• Bite marks or stinger

Bites and Stings

• Bites and Stings– Emergency Care

• 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 LifeInjuries

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 30-90 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 man-

of-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)


• 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


• Scorpion Fish, Stone Fish, Lion Fish– Envenomations– Immerse in non-scalding hot water to

tolerance (110-113oF or 43.3-45oC) for 30-90 minutes to reduce pain. Repeat if pain recurs.

– Keep extremity lower than heart level– Avoid excessive movement– Seek medical attention


• Bites– Control bleeding and attend to other life-

threatening problems– Treat as you would any open soft tissue

injury.– Seek medical attention as indicated.

poisoning and overdose emergencies. topic overview emergency medical care of poisoning / overdose...

Documents

ingested slide

liquichar slide

breakdown slide

overdoses treatment

overdoses poisonings

mental status slide

airway management slide

overdoses pediatric