20)Poisoning And Overdose
- 2. Poisoning and Overdose Poison/Toxin Any substance that usually kills, inures, or impairs an organism through its chemical actions. Toxicology Study of poisons Toxic Poisonous Overdose Self administration of a drug in excess OR in combination with other agents to the point where poisoning occurs. DTs “ Delirium Tremens” A severe form of alcohol withdrawal that involves sudden and severe mental or neurological changes
- 3. Introduction Regional Poison Center 1-800-222-1222 Second leading COD 2004 Exposure every 14 seconds 2,482,041 exposures in 2007 51.2% in childrem < 6 yo 73.3% fatalities bt 20-59 yo 32,691 poisoning deaths in 2005
- 6. Types of Exposure Ingestion Swallowing Suicidal pt with pills, Alcoholic with methanol, toddler/animal with antifreeze Injection Opioids – Insulin – Envenomation Inhalation CO is most common Glue sniffing Freebasing cocaine Absorption Organophosphate poisoning Corrosives (acids/alkali)
- 8. Poisoning and Overdose S/S per Route Ingested Hx of ingestions Nausea Vomiting Diarrhea AMS Abd pain Chemical burns around the mouth Different breath odors Emergent care Remove pills, tablets, fragments from pt mouth with gloved hands as needed, without injuring yourself Consult medical direction – Activated Charcoal Bring ALL containers, bottles, labels, etc of poison agent to hospital
- 9. S/S per Route: Inhalation S/S Hx of inhalation of toxic substance SOB Chest pain Cough Hoarseness Dizziness Headache Confusion Seizures AMS Singed nasal hairs Emergent care Have trained rescuers remove pt from scene Supplemental O2 Bring ALL containers, bottles, labels, etc of poison agent to hospital Smoke inhalation
- 10. S/S per Route: Absorbed S/S Hx of exposure Liquid or powder on pt skin Burns Itching Irritation Redness Emergent Care Remove contaminated clothing while protecting yourself Brush powders off pt Irrigate for at least 20 minutes of liquid exposure If in eyes, irrigate for at least 20 minutes and while en route away from unaffected eye
- 11. S/S per Route: Injection S/S Weakness Dizziness Chills Fever Nausea Vomiting Tack marks Emergent Care Airway patency and ventilation Be alert for vomiting Bring ALL containers, bottles, labels, etc of poison agent to hospital
- 12. Sedatives, Hypnotics, Anti-Anxieties Sedatives/Hypnotics/Anti anxiety Sedatives Calming, decrease activity Hypnotics Induce Sleep Examples: Barbiturates Benzodiazepines Ativan, Valium, Xanax, Sleeping Pills GHB Rohypnol S/S Resp depression Depressed LOC Coma Death
- 13. Opiods Opioids Narcotics CNS depressants Made from the Opium Poppy ( Papaver somniferum) Examples -Morphine – Codeine – Heroin – Oxycodone (Oxycontin)– Methadone – Meperidine (Demerol) – Fentanyl - Opium S/S CNS depression Depressed LOC Depressed Resp PINPOPINT PUPILS
- 14. Meperidine (Demerol) Methadone Morphine Morphine Opium Heroin
- 15. Stimulants Stimulants Stimulates CNS Increase alertness and physical activity Examples Amphetamines/Speed, Methamphetamine, Ritalin, Ecstasy, Cocaine, PCP, Nicotine S/S Excitability Seizures Increased heart rate Increased BP Chest pain Dysrhythmia Death Ischemia CVA MI Hyperthermia
- 16. Amphetamines- Adderall Cocaine Methamphetamine- Crystal Meth. Ritalin Ecstasy Nicotine
- 17. Ecstacy
- 19. Alcohol Alcohol Intoxicating agent in fermented and distilled liquors S/S AMS Motor deficit Coma Resp failure Vomiting Aspiration Death
- 20. Analgesics Analgesic Pain killers Examples Aspirin Acetaminophen Motrin Advil S/S Few early on Liver damage within 48 hrs
- 21. Organophosphates Organophosphates Inhibit acetylcholinesterase activity Initial overstimulation followed by disruption of nerve transmission Examples Insecticides Fertilizer Nerve gases S/S Over stimulation of secretions Bronchocontrsiction Weakness SLUDGE
- 23. Food Food Botulism Suspect When 2 of more people are ill after eating same food S/S Flu like S/S Double vision Trouble moving eyes/swallowing Head-to-toe weakness Paralysis Resp arrest Clostridium botulinum
- 24. Assessment HIGH level of suspicion Not always obvious Suspect when large number of people become ill at once i.e. Multiple people in a building with c/o headache, nausea, ALOC = CO poisoning Bring containers and labels with you Report noticeable odors Consider trauma ABC’s
- 25. General Approach Pt Hx ESSENTIAL High suspicion Date of prescription vs medication left ID/Quantity/Time of exposure/How/ Where exposed/Any treatments tried Transport pills/bottles Approach Vitals, Oxygen, Monitor, IV, Transport (VOMIT) Supportive care Aspiration? Consider AEIOU-TIPS Traditional approach Syrup of Ipecac (Airway compromise) Gastic lavage (Manpower, esophageal rupture) Activated charcoal (Relatively safe option)
- 26. Scene Size Up/Initial Assessment Scene Size-Up Scene safety/BSI Decontaminate pt Remove contaminated clothing Irrigate 20 minutes Brush off powders Initial Assessment General impression ABC’s LOC/AVPU Trauma? Most deaths are due to Respiratory Compromise Aggressively manage airway
- 27. Focused Hx/Px Hx What substance? When did pt ingest/become exposed? How much did the pt ingest? Over what time period? Interventions? How much does the pt weigh? Px Baseline Vitals Track marks? Some poisons present with a classical patter Opiods – PINPOINT pupil, AMS, Decreased/Shallow Resps Organophosphates – SLUDGE - Salivation – Lacrimation – Urination – Defecation – GI complaints – Emesis
- 28. Toxidromes Set of clinical S/S that are diagnostic of certain toxins/class of toxins Narcotics Decreased LOC, Res Depression, Constricted pupils Morphine, Codeine, Demerol (no pupil change), etc Anticholinergics “ Hot as Hades, blind as a bat, dry as a bone, red as a beet, mad as a hatter” Cholinergics Organophosphate poisoning SLUDGE Salivation, Lacrimation, Urination, Defecation, GI complaints, Emesis
- 29. Opioid Overdose
- 30. Salivation Lacrimation Urination Defecation GI Complaints Emesis Organophosphate Poisoning
- 31. Management Ensure Open Airway Ensure proper ventilation Prevent further absorption Activated Charcoal Treat S/S O2 Supportive Care ALS Naloxone Opioids Atropine Organophosphate
- 32. Re Assessment Re assessment Be alert for vomiting Be alert for further deterioration due to poisoning ABC’s Vitals LOC
- 33. Activated Charcoal Pharmacology Generic Activated Charcoal Trade SuperChar – InstaChar – Actidose – LiquiChar Indications Poisoning by toxic ingestion Contraindications AMS Inability to swallow Ingestions of alkali/acids Form Pre mixed in water with various amounts of charcoal. (12.5 g normal) Dose Adults/Children = 1g/kg of body weight Usual Adult dose = 25-50 g Usual child/infant dose= 12.5-25 g Route PO Actions Binds to certain poisons and blocks absorption Side Effects Black Stools Vomiting If pt vomits, repeat dose once
- 34. Activated Charcoal Administration Obtain order from medical control Shake container thoroughly Pt may need to be persuaded to drink medication since it looks like mud Cover container and supply a straw to aid in administration If pt takes a long time to drink the charcoal shake again as it will settle out of solution DOCUMENT activity and time Transport Re assess pt
- 35. Refusals Encourage pt to go to hospital Call police if needed Pt cannot be assumed to be acting in best intent if OD/Suicidal/AMS.