Transcript Chapter_021 689KB Jan 14 2015 08:21:52 AM

Chapter 21
Poisoning and Overdoses
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 1
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.
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 2
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
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 3
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
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 4
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
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 5
Types of Poisonings

Ingested

Injected

Inhaled

Absorbed
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 6
Cardinal Rules

Treat the patient, not
poison.

Protect self and
bystanders.

Look for clues of trauma.

Maintain a high level of
suspicion.
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 7
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.
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 8
Initial Assessment

What is your general
impression?

Findings indicate any trauma?

Is the patient awake and
responsive?

Airway, Breathing, Circulation
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 9
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?
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 10
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?
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 11
Perform a
Focused Physical Examination



Skin
Pupils
Breath sounds



Abdomen
Mental status
Vital signs
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 12
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
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 13
Ingested Poisons –
Signs and Symptoms




History of ingestion
Nausea
Vomiting
Diarrhea
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 14
Ingested Poisons –
Signs and Symptoms

Altered mental status

Abdominal pain

Chemical burns around
the mouth

Different breath odors
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 15
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
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 16
Emergency Medical Care


Remove poison from patient’s
mouth using gloves.
Consult medical direction.


Activated charcoal
Bring all containers (bottles,
labels, etc.,) to hospital.
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 17
Types of Ingestions

Sedative-hypnotics

Antianxiety agents

Opioids

Psychiatric medications

Stimulants
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 18
Types of Ingestions –
Sedative-Hypnotics

Barbiturates



Secobarbital (Seconal)
Pentobarbital (Nembutal)
Benzodiazepines



Diazepam (Valium)
Chlordiazepoxide (Librium)
Chlorazepate (Tranxene)
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 19
Types of Ingestions –
Sedative-Hypnotics

Others




Methaqualone (Quaalude)
Ethchlorvynol (Placidyl)
Chloral hydrate (Noctec)
Mebrobamate (Miltown)
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 20
Toxic Effects –
Sedative-Hypnotics

Altered mental status

Respiratory depression
and arrest

Most toxic when
combined with alcohol

Support of ABCs is
critical.
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 21
Types of Ingestions
Opioids (Narcotics)

Central nervous system depressant

Examples
• Heroin
• Morphine
• Percocet
• Percodan
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 22
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
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 23
Ingested Substances

Stimulants

Cause increased
excitability (e.g.,
amphetamines)

Alcohol

Heart and lung drugs

Analgesics
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 24
Inhaled Poisons –
Signs and Symptoms

History of inhalation of
toxic substance

Dizziness

Headache

Difficulty breathing

Chest pain

Confusion

Cough

Seizures

Hoarseness

Altered mental status
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 25
Poisonous Gases

Simple asphyxiants

Carbon dioxide

Small hydrocarbon molecules

Chemical asphyxiants

Irritant gases

Organophosphates
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 26
Toxic Injection –
Signs and Symptoms

Weakness

Dizziness

Chills

Fever

Nausea

Vomiting
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 27
Absorbed Poisons –
Signs and Symptoms

History of exposure

Liquid or powder on patient’s skin

Burns

Itching

Irritation

Redness
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 28
Emergency Medical Care

Skin



Powder




Remove contaminated clothing.
Protect self from contamination.
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.
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 29
Medication Name

Generic


Activated charcoal
Trade




SuperChar™
InstaChar™
Actidose™
LiquiChar™
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 30
Activated Charcoal

Indications


Poisoning by mouth
Contraindications



Altered mental status
Ingestion of acids or alkalis
Inability to swallow
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 31
Medication Form

Medication is pre-mixed in water.


Plastic bottle containing 125 grams activated
charcoal
Powder should be avoided in field.
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 32
Dosage

Adults and children


Usual adult dose


1 gram activated charcoal/kg of body weight
25 - 50 grams
Usual infant/child dose

12.5 - 25 grams
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 33
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.
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 34
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.
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 35