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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
• 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• 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?
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
• Most common inhaled poison• Vehicle exhaust and fire suppression• Odor-less and color-less• Signs & Symptoms
– 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
• 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
• 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)
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 30-90 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 life-
threatening problems– Treat as you would any open soft tissue
injury.– Seek medical attention as indicated.