Chapter 22 - Toxicology

Toxicology

study of toxic/poisonous substances

Poison

substance that damages body structures and impairs body function

Toxin

• Poisonous substance produced by bacteria, animals, or plants that changes a cell’s metabolism or destroys it

• acute and chronic effects

Substance Abuse

misuse of any substance to produce a desired effect

Overdose

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

Ingestion

swallowing

Signs of Opiate/Opioid Overdose

• Hypoventilation/respiratory arrest

• Pinpoint pupils

• Sedation or coma

• Hypotension

Signs of Sympathomimetic Overdose

• Hypertension

• Tachycardia

• dilated pupils

• Agitation

• Seizures

• Hyperthermia

Signs of Sedative-Hypnotic Overdose

• slurred speech

• sedation or coma

• hypoventilation

• hypotension

Signs of Anticholinergic Overdose

• tachycardia

• hyperthermia

• hypertension

• dilated pupils

• dry skin/mucous membranes

• sedation, agitation, seizures, coma, delirium

• decreased bowl sounds

Signs of Cholinergic Overdose

• Airway compromise

• SLUDGEM

  • Salivation/sweating

  • Lacrimation

  • Urination

  • Deification, drooling, diarrhea

  • Gastric upset and cramps

  • Emesis

  • Muscle twitching/miosis

Antidote

substance that counteracts the effects of a particular poison

4 Routes Poisons Enter the Body

1. Inhalation

2. Absorption

3. Ingestion

4. Injection

Inhaled Poison Examples

• Natural gas

• Sewer gas

• Pesticides

• Carbon Monoxide Chlorine

Treating Inhaled Poisons

• move to fresh air

• supplemental O2 if needed

• don’t approach pt w/o PPE

• Call Hazmat team if needed

• Transport to ED

Signs of Inhaled Poisons

• burning eyes

• sore throat

• cough

• chest pain

• hoarseness

• wheezing

• respiratory distress

• dizziness

• confusion

• headache

• stridor

• altered mental status

• confusion

Signs of Absorbed Poisons

• history of exposure

• liquid or powder on pts skin

• burns

• itching

• irritation

• red skin

• odors of the substance

Examples of Absorbed Poisons

• Acids

• Alkalis

• Petroleum

• Poison Ivy/Oak

Treatment for Contact Poisoning

• Avoid contamination of self and others

• Remove substance from patient ASAP

  • remove clothes

  • brush off chemical & flush skin with clean water (Powder)

  • flood effected part (liquid)

• Grab material safety data sheet (MSDS)

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)

Ingested Poison Examples

• liquids

• household cleaners

• contaminated food

• plants

• drugs

Signs of Ingested Poisons

• Very based on type of poison, age, time since ingestion

• crying in children

• gastrointestinal pain → vomit

• altered mental status

• seizures

• cardiac dysrhythmias

Injected Poison Examples

• IV drug abuse

• Envenomation by insects, arachnids and reptiles

Signs of Injected Poisons

• weakness

• dizziness

• fever

• chills

• slow breathing

• unresponsiveness

• easy excitement

Treating Injected Poisons

• monitor airway

• provide high flow O2 if needed

• prepare for nausea/vomiting

• Remove jewelry from around injection site

• Transport to ED

• Take all substances to the hospital

Emergency Medical Care with Poison

• Scene safety

• Suction pills from pts mouth

• brush off dry poisons from skin

• Assess/maintain XABC

• Provode O2

• Assist ventilations if needed

• Keep pt warm

• Treat for Shock if needed

Contraindications for Activated Charcoal

• alkali poisons

• cyanide

• ethanol

• iron

• lithium

• methanol

• mineral acids

• organic solvents

• Decreased LOC

• Unprotected airway

Activated Charcoal Doses

1g for 1 kg of body weight

Administering Activated Charcoal

1. Med control approval

2. Shake bottle

3. Have pt drink until finished

4. discard container

Tolerance

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

Addiction

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

• Addicts typically have increased tolerance

• Almost any substance can be an addiction

Alcohol

• CNS Depressent

• Sedative

• Hypnotic

• dulls reflexes

• increases reaction time

• behavior may be inappropriate and aggressive

• Increases effects of other drugs

Sedative

substance that decreases activity and excitement

Hypnotic

induces sleep

Treating Alcohol Poisoning

• give O2 but be aware of possible emesis

• internal bleeding can also be considered

Delirium Tremens (DTs)

• Severe withdrawal symptoms of alcoholics deprived of ethyl alcohol

• characterized by restlessness, fever, sweating, disorientation, agitation, and seizures

• can be fatal

Narcotic

drug that produces sleep or altered mental consciousness

Opioid

narcotic medication used to relive pain

Opiate

natural, non synthetic opioids

Opioid/Opiate Examples

Butorphanol (Stadol)

Codeine

Fentanyl (Sublimaze)

Heroin

Hydrocodone (Vicodin)

Hydromorphone (Dilaudid)

Morphine

Methadone (Dolophine)

Oxycodone hydrochloride (OxyContin)

Oxymorphone (Opana)

Treating Opioid Poisoning

• Place airway & ventilate

• Narcan via IV, IN, IM

  • only when agonal respirations/apnea is present

Sedative-Hypnotic Drug Examples

Barbiturates

• Ambobarbital

• Butabarbital

• Pentobarbital

• Phenobarbital

• Secobarbital

Benzodiazepines

• Alprazolam (Xanax)

• Chloridazepoxide (Librium)

• Diazepam (Valium)

• Flunitrazepam (Rohypnol)

• Lorazepam (Ativan)

• Oxazepam (Serax)

• Temzepam (Restoril)

Others

• Ethyl alcohol

• Isopropyl Alcohol

• Ketamine

Treating Sedative-Hypnotic Poisonings

• Keep airway patent

• assist ventilation

• supplemental O2

• Transport ASAP

• Watch for vomiting

Abused Inhalants Examples

• Acetone

• Toluene

• Xylene

• Hexane

• Gasoline

Treating Abused Inhalants

• prevent pt exertion

• give supplemental O2

• stretcher to move pt

• Transport ASAP

• monitor vitals en route

Hydrogen Sulfide Poisoning

• occurs via inhalation

• gas smells like rotten eggs

• impacts all organs → biggest impact on lungs and CNS

Signs of Hydrogen Sulfide Poisoning

• irritation of ENT

• headaches

• bronchitis

• inability to smell gas

• nausea/vomiting

• confusion

• dyspnea

• loss of consciousness

• seizures

• shock

• coma

• cardiopulmonary arrest

Sympathomimetics

• CNS stimulates that mimic the affect of fight/flight nervous system

• ex: meth

• taken by mouth/smoked

Stimulant

agent that produces an exited state

Bath Salts (Synthetic Cathinones)

• Induce Euphoria

• increased mental clarity & sexual arousal

• Taken nasally

• Adverse effects: teeth grinding, appetite loss, muscle twitching, lip-smacking, confusion, paranoia, headache, elevated heart rate, hallucinations

Hallucinogen

• alters sensory perceptions

• effective by most routes

• causes severe behavioral changes via hallucinations, intense vision & hearing

Hallucinogen Examples

Bufotenine (toad skin)

Datura stramonium (jimsonweed)

Dextromethorphan (DXM)

Dimethyltryptamine (DMT)

Ketamine

LSD

Mescaline (peyote)

Morning glory

Nutmeg

PCP

Psilocybin

Salvia

Anticholinergic Agents

• block parasympathetic nerves

• exhibit hyperthermia, dilated pupils, dry/reddened skin, delirium

Cholinergic Agents

• overstimulate normal body functions controlled by parasympathetic nervous system

• common in chemical weapons and insecticides

• SLUDGEM

• Avoid exposure to self

Signs of Aspirin poisoning

• nausea/vomiting

• hyperventilation

• ringing in ears

• anxiety/confusion

• tachypnea

• hyperthermia

• seizures

Examples of Fatally Ingested Poisons

Sedative-hypnotics (alprazolam [Xanax], diazepam [Valium], zolpidem [Ambien])

Calcium channel blockers (verapamil, nifedipine, diltiazem)

Stimulants and street drugs

Opioids (heroin, fentanyl, oxycodone)

Beta blockers (metoprolol, atenolol)

Acetaminophen alone or combinations

Alcohols

Antidepressants (selective serotonin reuptake inhibitors such as sertraline [Zoloft] and others)

Hypoglycemic drugs

Acetylsalicylic acid (aspirin, oil of wintergreen)

Tricyclic antidepressants (amitriptyline [Elavil], imipramine [Tofranil], nortriptyline [Pamelor])

Food Poisoning

• caused by eating food contaminated by bacteria

• organism can cause the disease or produce toxins that cause the disease

Botulism Poisoning

• result of eating improperly canned food

• blurring of vision

• weakness difficulty breathing/speaking

• paralysis

• can be fatal

Treating Plant Poisoning

1. Assess pts airway and vital signs

2. Notify regional poison center

3. Take pt to ED ASAP