AET 261 chapter 14 - Poisoning

Poison

a substance that causes injury, death, or impairment of an organism through chemical action

poisoning

a sudden illness brought on by external substances ranging from mild irritation to death

poison comes in forms of

solid, liquid or gas. The most common cause is carbon monoxide

poison control centers are operated

provincially

most common “poisons” for children

1. cough/cold medicines

2. pain/fever medicines

3. cleaning solutions

4. plants

ingestion

swallowed and enters the body through the digestive system

inhalation

breathed in gases or fumes

absorption

enters the body through the skin and tissues

injection

enters through bites, stings, or hypodermic syringes (breaks the skin)

general s/s of a poisoning

1. nausea/vomiting 

2. chest/abdominal pain

3. breathing difficulty

4. Altered LOR

5. Seizures

6. burns/rashes around mouth

7. rashes

8. Diarrhea

what about the scene can also point to a poisoning

1. odors

2. flames/smoke

3. open/empty/spilled containers

4. overturned/damaged plants

key components to a poison scenario

• if there’s vomit, try to get a sample

• remove the patient from the source

• primary as normal (if you know it’s poison right away, just call 911)

• call poison control and follow their instructions!

4 crucial pieces of information to gather for poison control

1. what type of poison is it?

2. how did the contamination occur?

3. when did it occur?

4. how much of it? quantity of the poison

specific s/s of ingestion poisoning

1. open container nearby

2. burns around the mouth

3. unusual odor on their breath

4. increased production of saliva or saliva that is an abnormal color

5. abdominal cramps

6. vomiting or diarrhea

7. burning sensation in mouth, throat, or stomach

8. dizziness or drowsiness

9. unresponsiveness

10. seizures

for ingested poisons, you may be instructed to:

1. induce vomiting

2. use activated charcoal

3. give the patient water

s/s for inhaled poisonings

1. respiratory arrest, distress, or dyspnea

2. irritated eyes, nose, or throat

3. cyanosis around the mouth

4. unusual smell in their air or on the patients breath

5. vomiting

6. dizziness

7. seizures

8. unresponsiveness

treatment for inhaled poisons:

perform any interventions needed for respiratory distress and arrest then call 911 poison control

s/s for absorbed poisonings

itching, red rash, swelling, bumps/streaking/weeping blisters

treatment for absorbed poisons

upon discovery in secondary assessment, call poison control. You may be instructed to apply a cream or ointment for itching/blistering, suggest the patient take an oral anti-histamine, refer to a physician

for wet or dry chemicals treat:

treat like a chemical burn (wipe/brush, rinse for 20 minutes)

s/s for injected black widow bite

1. raised, round, red mark

2. cramping pain in legs, abd, and shoulders

3. restlessness and anxiety

4. dizziness

5. headache

6. excessive sweating

7. weakness

8. pain can range from mildly irritation to unbearable

s/s of a brown recluse bite

1. slight stinging sensation

2. blood filled blister that appears 2-8 hrs

3. bulls eye pattern around the bite

3 venomous snakes in canada

1. northern pacific rattlesnake

2. Mississauga rattlesnake

3. prairie rattlesnake

treatment for snake bites

1. keep the injured site still, if possible position at or below heart level

2. if on a limb, remove jewelry and tight clothing

3. wash the wound with water

4. cover with a clean, dry, sterile dressing

call EMS for poison control and follow instructions

Drug

any substance that is taken to affect the function of the body

medication

a drug used to prevent or treat a disease or condition

stimulants

a class of substances that alters the CNS by speeding up physical and mental activity. mostly ingested but some are absorbed or inhaled

common examples of stimulants

1. asthma medications

2. amphetamines

3. methamphetamine

4. cocaine

5. crack

6. nicotine

7. diet pills

8. coffee

9. chocolate

s/s of stimulant misuse or abuse

1. moist and flushed skin

2. sweating

3. chills

4. nausea

5. vomiting

6. fever

7. headache

8. dizziness

9. tachycardia

10. tachypnea

11. high blood pressure (hypertension)

12. chest pain

depressants

a class of substances that affect the CNS by slowing down physical and mental activity (they are used in the medicinal world commonly)

common examples of depressants

1. alcohol

2. barbiturates (a class of sedatives/sleep drugs)

3. narcotics

4. benzodiazepines

5. opioids 

what do depressants do?

• relieve anxiety

• promote sleep

• depress respirations

• relieve pain

• relax muscles

• impair coordination and judgement

hallucinogens

a class of substance that cause changes in mood sensation, thought, emotion, and self awareness

s/s of hallucinogen misuse/abuse

1. panic

2. paranoid delusions

3. vivid hallucinations

4. profound depression

5. tension & anxiety

common examples of hallucinogens

1. lysergic acid diethylamide (LSD)

2. psilocybin (mushrooms)

3. phencyclidine (angel dust)

Opioids

a class of depressants including morphine, fentanyl, and heroine 

why are opioids so dangerous?

they pose a high risk of fatal overdose because they bind to receptors in the brain that control respiration, rapidly causing respiratory arrest.

s/s of opioid misuse/abuse

1. severely reduced LOR or unresponsive

2. severely constricted pupils or rolled back eyes

3. limp muscle

4. slow or absent pulse

5. slow or absent respirations

6. low spO2

7. cold, pale, bluish skin

8. vomiting

Risks for opioid poisoning

1. mixing of substances

2. change in tolerance or health leading to increased sensitivity

3. previous experience leading to risk taking behaviour

4. variation in strength/content/supplier of street drugs

important keys for substance misuse/abuse scenes

1. be aware of any drug paraphernalia such as needles

2. bystanders that are under the influence

3. infectious bodily fluids

4. Crime scenes (try not to touch anything, preserve evidence)

5. Opioid sources (powder, patches, pills, etc.)

naloxone

a drug that rapidly counteracts the affects of opioid overdose by binding to the same receptors in the brain, displacing the opioids and preventing respiratory arrest. (sweepers)

how can naloxone be administered

intranasally, intramuscularly, or subcutaneously

opioid overdose treatment

if the patient is not breathing or displaying only agonal breathing immediately begin CPR (if you have a mask, provide assisted ventilations), administer naloxone (can be readministered 3-5 mins after if there’s no improvement). Call EMS

designer drugs

drugs manufactured or modified from other drugs or household items, serve no medicinal purpose

general guidelines for substance misuse/abuse

• not the time to judge

• follow poison protocol (call ems for poison control)

• obtain information from bystanders (what was taken, how much, when?)

• be careful that the patient may be irrational, aggressive, violent, or withdrawn (keep a safe distance, protect yourself first)