Toxicology EMT (EMS 132)

the 4 routes of exposure

inhaled, injected, ingestion, absorbed/integument

ingested S/S

AMS, difficulty breathing, abdominal pain, burns around mouth, N/V, diarrhea

absorbed s/s

AMS, burns, itching, rashes, dyspnea, N/V

inhaled s/s

AMS,, dyspnea, headache, dizziness, discoloration around mouth

injected s/s

AMS, dyspnea, swelling, soreness, discolorationaround injection sight

ingested treatment

consider activated charcoal, ABCs, LOC

inhaled rx

ABCs and LOC, provide o2 if indicated, remove them from source

injected rx

try to identify drug or animal

absorbed rx

remove contaminated clothing

brush dry chems off carefully, then wash for 20 min

wash wet stuff off for 20 mins

toxidrome

a generalized classification of poisons into groups, based upon similar signs and symptoms.

anticholinergic examples

atropine, diphenhydramine

anticholinergic s/s

think parasympathetic system turns off

blind as a bat- dry dilated pupils

mad as a hatter- confusion, delirious

Red as a beat- flushed skin

hot as a hare- hot 

dry as a bone- dry skin, dry mouth,

full as a flask- urinary retention, abdominal distention/decreased motility

other s/s = normal RR, increased HR, increased BP, ataxia- inability to coordinate voluntary movements

cholinergic examples

organophosphate, parasympathomimetic, muscarinic, nicotine, acetylcholine, GI motility drugs, mushrooms

cholinergic s/s

Think parasymp overdrive

lethargy, seizures

normal bp and temp, weird muscle movements

Defecation

Urination

miosis- pupil constriction

Bradycardia, brochospasm, and bronchorrhea- later sign

Emesis

Lacrimation

Salivation/sweating

opioid examples

morphine, codeine, oxycodone, heroine, fentanyl, carfentanyl, sufentanyl

opioid s/s

miosis

decreased RR

sometimes decrease in BP, HR, and temp

unresponsive

euphoria-happy

dry skin

muscle weekness, lethargy

cyanosis

sympathomimetic examples (stimulant)

caffeine, cocaine, amphetamines, PCP, ecstacy (MDMA), hallucinogens, meth

sympathomimetic s/s

increases fight/flight

often comes with trauma….

agitation, aggression, dilated pupils, increase in HR, BP, and temp

decrease in gi motility

sweaty

muscle twitching

hypervent

bronchodilation

toxin exposure expansion ?s

what did you take?

How much?

what time"?

All at once?

Eat or drink anything before or after?

antidote or treatment

how much do you weigh

how was it taken (IV, ingested, etc)

marks on body from continued IV use in drugs

track marks

a severe withdrawl syndrome in alcoholics characterized by restlessness, fever, sweating, disorientation, agitation, and seizures- can be fatal

delirium tremens (DTs)

opiate vs opioid

opiate= natural

opioid=synthetic

when would restraining someone cause harm possbly? How?

sympathomimetic- cardiac dysrythymias

what other things could happen if someone takes drugs.

there could be additives that can clog blood vessels to the lungs, liver, kidneys, or brain. 

sedative/hypnotic examples

muscle relaxants, anti-anxiety, epileptic, barbiturates, benzodiazepines, xanax, rubbing alcohol

sedative/hypnotic s/s

lethargy

pupils slightly dilated or normal

decrease in HR, BP, RR, and temp

dry skin

ataxia- cant move well

alcohol S/S

flushed face

smell

behavior

drowsiness

slurred speech

N/V

disease that alcohol can cause

liver disease, pancreatitis, ulcers, cancer, malnourishment, heart disease

8- 24 hours/ stage 1 alcohol withdrawal

alcohol tremulousness- cant concentrate, irritable, insomnia, sweating, nausea

24-72 hours/stage 2 alcohol withdrawal

alcohol hallucinosis- hallucinations, seizures

2-5 days/stage 3 alcohol withdrawal

delirium tremens- seizures, disoriented, mood change, deep sleep for 24 hours

what is serotonin

a neurotransmitter that helps with mood, anxiety, and happiness- not enough=depression

so anti anxiety meds increase it

when you od on serotonin its called

serotonin syndrome

serotonin meds examples

Selective serotonin uptake inhibitors- prozac/fluoxetine

demerol-an opioid that helps it

can be worse when mixed with certain other drugs

serotonin syndrome s/s

confusion, dilated pupils, increase in HR, BP, RR, temp, increase gi motility, N/V, sweaty, hyperreflexia- over response of reflexes, ataxia

CO poisoning s/s that idk

tachypnea, n/v, headache

heroin and cocaine mixed

speedball

cocaine and amphetamine

supercrank

cocaine and alchohol

crack cooler

CV rx meds OD

can cause different s/s

get an EKG

Acetaminophen

anti pyretic and analgesic

even proper use can cause OD 

S/S- n/v, fatigue, abdominal pain

can cause painful liver failure and death

hydrocarbons examples

found in kerosene, lighter fluid, glues, paints

huffing

what is it

S/S

usually involves volatile (easily vaporized) hydrocarbons like gasoline

S/S

eratic pulse and blood pressure

RR can be fast or slow

swollen mucous membranes

DYSRHYTHMIAS when paired with their adrenaline

bath salts s/s plus their other name

synthetic cathinones - eratic violent behavior similar to  amphetamine use

hydrogen sulfide

rotten egg gas that is toxic- sewers, swamps, valcanoes

hallucinogens

make people hallucinate (shocker)

ex- LSD/ lysergic acid diethylamide

suffix olol

betta blockers

  suffix -lol (generic names)

Alpha/beta-adrenergic blockers

betta blockers care

activated charcoal, check bgl

aspirin

ringing in ears, vomiting, nasea, rapid breathing, anxiety, hyperthermia, seizures

dont slow down their breathin, it is helping