Transcript Overdose
Poisoning Poisons Substance which when introduced into body in relatively small amounts causes in structural damage or functional disturbances Suspect with: 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 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 Medical Uses – analgesics – anti-diarrheal agents – cough suppressants Narcotics Overdose Coma Respiratory depression Constricted (pin-point) pupils Narcotics 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 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 Overdose – – – – 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 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