EMT Chapter 22*30 Toxicology

Addiction

A state of overwhelming obsession or physical need to continue the use of a substance.

Antidote

A substance that is used to neutralize or counteract a poison.

delirium tremens (DTs)

A severe withdrawal syndrome seen in alcoholics who are deprived of ethyl alcohol; characterized by restlessness, fever, sweating, disorientation, agitation, and seizures; can be fatal if untreated.

Emesis

vomiting

Hallucinogen

An agent that produce false perceptions in any one of the five senses.

hematemesis

vomiting blood

Hypnotic

A sleep-inducing effect or agent.

Ingestion

Swallowing; taking a substance by mouth.

Material Safety Data Sheet (MSDS)

A form, provided by manufacturers and compounders (blenders) of chemicals, containing information about chemical composition, physical and chemical properties, health and safety hazards, emergency response, and waste disposal of a specific material; also known as a safety data sheet (SDS).

Narcotic

a drug that produces sleep or altered mental consciousness

Opiate

A subset of the opioid family, referring to natural, non-synthetic opioids.

Opioids

A synthetically produced narcotic medication, drug, or agent similar to the opiate morphine, but not derived from opium; used to relieve pain

Overdose

An excessive quantity of a drug that, when taken or administered, can have toxic or lethal consequences.

Poison

a substance that causes illness, injury or death if taken into the body or produced within the body.

Sedative

A substance that decreases activity and excitement.

Stimulant

An agent that produces an excited state (mimics fight or flight)

Substance abuse

The misuse of any substance to produce a desired effect.

Tolerance

The need for increasing amounts of a drug to obtain the same effect.

Toxicology

The study of toxic or poisonous substances.

Toxin

A poison or harmful substance.

Poisoned is categorized into _____ and ______

Acute; Chronic

_____ poisoning affects over 2 million people each year

Acute

_____ poisoning is more common (caused by abuse of medications, tobacco, alcohol, drugs)

Chronic

Poison is any substance whose

chemical action can damage body structures or impair body function

Toxin is a

poisonous substance produced by bacteria, animals, or plants

Substance abuse is the

misuse of any substance to produce a desired effect

Overdose is a toxic

dose of a drug

Four routes to consider for poisons

Inhalation, Absorption, Ingestion, Injection

Types Inhaled Poisons

gas, sewer gas, pesticides, CO, chlorine

Inhaled Poisons, Move the patient into

fresh air immediately

Some patients use inhaled poisons to commit suicide in a vehicle

Contact HazMat responders and have them remove the victim

Absorbed and Surface Contact Poisons Signs and symptoms include

history of exposure, Liquid or powder on a patient’s skin, Burns, Itching, Irritation, Redness of skin, Typical odors of the substance

If dry powder has been spilled

brush off the powder, flood the area with water for 15 to 20 minutes, then wash skin with soap and water

Many chemical burns occur in

industrial setting

About 80% of poisoning is by

mouth

Ingested Poisons Signs and symptoms

burns around the mouth, gastrointestinal pain, vomiting, cardiac dysrhythmias, and seizures

Injected Poisons Cannot be

diluted or removed from the body in the field

Injected Poisons Signs and symptoms

weakness, dizziness, fever/chills, unresponsiveness, and excitability

Everyone who is exposed to the hazardous material must be

thoroughly decontaminated by the hazmat team before leaving the scene

Communication and documentation - Bring the material data sheet to the hospital if

the poisoning occurred in a work setting (front wall/pillar)

Activated charcoal

binds to specific toxins, which are then carried out of the body in the stool

Activated charcoal Contraindicated in patients who have

Ingested alkali poisons, cyanide, ethanol, iron, lithium, methanol, mineral acids, or organic solvents; A decreased LOC and cannot protect their airway

If local protocol permits, you may carry a premixed suspension of 50 g

of activated charcoal (Typical Adult dose - 30 to 100g; Child dose - 15 to 30g)

The usual dose of activated charcoal for an adult or child is

1 g per kilogram of body weight

Before you give a patient charcoal

obtain approval from medical control

Alcohol is a powerful

CNS depressant (Sedative and Hypnotic)

Alcohol [withdrawl]

Patients may experience frightening hallucinations, or delirium tremens (DTs)

DT’s occur about

1-7 days after a person stops drinking

DTs are characterized by

Agitation and restlessness, Fever, Sweating, Tremors, Confusion/disorientation, Delusions/hallucinations, Seizures

Opioids Patients typically appear sedated or unconscious and cyanotic with

pinpoint pupils

Naloxone

reverses the effects of opiate or opioid overdose (Place an oropharyngeal airway and ventilate the patient using a BVM prior to administering naloxone)

Barbiturates and benzodiazepines are

CNS depressants

Sedative-Hypnotic Drugs

Alter the level of consciousness; Patient may appear drowsy, peaceful, or intoxicated

Sedative-Hypnotic Drugs are generally taken by

mouth

Inhalants

briefly displace oxygen in the brain and cause a rush of euphoria

Abused Inhalants, Always use

special care (Even the action of walking may cause SUDDEN DEATH)

Hydrogen sulfide

A highly toxic, colorless, and flammable gas with a distinctive rotten-egg odor; Affects all organs, but it has the most impact on the lungs and CNS - Used to commit suicide

Hydrogen Sulfide Signs and symptoms

Nausea and vomiting, confusion, dyspnea, a loss of consciousness, seizures, shock, coma, and cardiopulmonary arrest

Sympathomimetics like Cocaine

may be taken in a number of different ways

Acute overdose of Sympathomimetics is

a genuine emergency

Synthetic Cathinones (Bath Salts)

An emerging class of drugs similar to MDMA (Molly); Produce euphoria, increased mental clarity, and sexual arousal

Synthetic Cathinones (Bath Salts) Adverse effects include

Teeth grinding, appetite loss, muscle twitching, lip-smacking, confusion, gastrointestinal conditions, paranoia, headache, elevated heart rate, and hallucinations

Marijuana is abused

throughout the world (Synthetic); “Spice”

Hallucinogens - Patients can become

VERY violent

Anticholinergic Agents

Have properties that block the parasympathetic nerve; “Hot as a hare, blind as a bat, dry as a bone, red as a beet, and mad as a hatter" (Benadryl, jimsonweed, and amitriptyline)

Cholinergic Agents

Overstimulate normal body functions that are controlled by the parasympathetic nerves

Cholinergic Agents Use the mnemonic

DUMBELS & SLUDGEM

Antidote kit (DuoDote Auto-Injector) may be available for

Cholinergic Agents

Aspirin poisoning

potentially lethal condition

Ingesting too many aspirin may result in

Nausea, Vomiting, Hyperventilation, *Ringing in the ears

Two main types Food Poisoning

Organism itself may cause disease; Organism may produce toxins that cause disease

One organism that produces direct effects of food poisoning is the ______ bacterium

Salmonella

Causes of salmonellosis

Characterized by severe GI symptoms within 72 hours of ingestion, including nausea, vomiting, abdominal pain, and diarrhea

The more common cause of food poisoning is the ingestion of powerful toxins produced by bacteria, often in _________

leftovers

The bacterium ________ is quick to grow and produce toxins in food

Staphylococcus

The most severe form of toxin ingestion is

botulism

Botulism

result from eating improperly canned food (Symptoms are neurologic - Blurring of vision, Weakness, Difficulty in speaking and breathing)

Which of the following questions is of LEAST pertinence for the EMT to ask a patient who intentionally overdosed on a medication?

“Why did you take the medication?”

A 30-year-old male who ingested an unknown substance begins to vomit. You should

collect the vomitus and bring it to the hospital

When caring for a patient with a surface contact poisoning, it is important to remember to

avoid contaminating yourself or others

Most poisonings occur via the _________ route

ingestion

How much activated charcoal should you administer to a 55-pound child who swallowed a bottle of aspirin?

25 g

After taking Vicodin for 2 years for chronic pain, a 40-year-old woman finds that her usual dosage is no longer effective and goes to the doctor to request a higher dosage. This is an example of

tolerance

Which of the following effects does drinking alcohol NOT produce?

Increased sense of awareness

A 21-year-old male was found unconscious in an alley. Your initial assessment reveals that his respirations are slow and shallow, and his pulse is slow and weak. Further assessment reveals that his pupils are bilaterally constricted. His presentation is MOST consistent with an overdose of

an opioid

The mnemonic DUMBELS can be used to recall the signs and symptoms of a cholinergic drug poisoning. The “E” in DUMBELS stands for

emesis

Food poisoning is almost always caused by eating food that contains

bacteria

As you enter the residence of a patient who has possibly overdosed, you should

be alert for potential hazards

A hypnotic drug is one that

induces sleep

Activated charcoal is given to patients who have ingested certain substances because it

binds to the substance and prevents absorption

A 25 year old man overdosed on heroin and is unresponsive. His breathing is slow or shallow and he is bradycardic. He has track marks on both arms. The EMT should

insert a nasal airway and ventilate with a BMV

Which of the following statements regarding inhaled poisons is correct?

lung damage might process after the patient is removed from the environment

It is most important to determine a patient's weight when asking questions pertaining to a toxic ingestion because

activated charcoal is given based on a patient's weight

You are dispatched to a local nursery for a 39 year old female who is sick. When you arrive, you find the patient lying on the floor. She is semiconcious, has copious amounts of saliva coming from her mouth, and is incontinent of urine. You quickly feel her pulse and note that it is very slow. Immediate management for this patient should include

thoroughly suctioning her oropharynx

Hypotension, hypoventilation, and pinpoint pupils would be expected following an overdose of

oxycodone (Percocet)

You respond to a local motel for a young female who was sexually assaulted. The patient is concious but confused. She tells you that the last thing she remembers was drinking beer at a club with her friends the night before. When she awoke, she was in a bed of the motel room. You should suspect that this patient

was given flunitrazapam (Rohypnol)

Which of the following drugs is not a sedative hypnotic?

oxycodone (Percocet)

Naloxone (Narcan) would reverse the effects of

hydromorphone (Diladid)

During your assessment of a 50 year old male who was found unresponsive in an alley, you note that he has slow, shallow respirations; bradycardia; facial cyanosis; and pinpoint pupils. As your partner begins assisting the patient's ventilations, he directs your attention to the patient's arms, which have multiple needle tracks on them. Which of the following most likely explain the patient's presentation?

heroin overdose

Delirium tremens (DTs) is a syndrome associated with withdrawl from

alcohol