Chapter 22: Toxicology

What is the overall constellation of signs and symptoms relating to toxicology called?

Toxidrome

What are the typical signs and symptoms for opioid (heroin, methadone, oxycodone, morphine, cocaine) overdoses?

• Hypoventilation or respiratory arrest

• Pinpoint pupils

• Sedation or coma

• Hypotension

What are the typical signs and symptoms for stimulant/ sympathomimetics (mephedrone, cocaine, meth, adderall) overdoses?

Hypertension, Tachycardia, dilated pupils, agitation or seizures, hyperthermia

What are the typical signs and symptoms of sedative - hypnotic ( diazepam, alprazolam) overdoses?

Slurred speech, sedation or coma, hypoventilation, hypotension

What are the signs and symptoms of anticholinergics (atropine, jimsonweed)?

Tachycardia, hyperthermia, hypertension, dilated pupils, dry skin and mucous membranes, sedation agitation seizures coma or delirium, decreased bowel sounds

What are the signs and symptoms of a cholinergic (nerve gas) overdose?

Airway compromise

SLUDGEM:

• S: Salivation, sweating,

• L: Lacrimation (tearing of eyes)

• U: Urination

• D: Defecation, drooling, diarrhea

• G: Gastric upset and cramps

• E: Emesis (vomiting)

• M: Muscle twitching/miosis (pinpoint pupils)

Inhaled poison signs and symptoms

Dyspnea, burning eyes, sore throat, cough, chest pain, hoarseness, wheezing, respiratory distress, dizziness, confusion, headache, or stridor

What kinds of chemicals can be considered surface contact poisons?

Acids, alkalis, and some petroleom

What sign/symptom is common in children who ingest an acid or aklaline?

Crying because of severe gastrointestinal pain

Injected poisons signs and symptoms

Weakness, dizziness, fever, chills, slow breathing, unresponsiveness, or easily excited

What questions should you ask, in addition to SAMPLE history, when a patient is suspected of a poisoning?

What is the substance involved?

When did the patient ingest or become exposed to the substance?

How much did the patient ingest or what was the level of exposure?

Over what period did the patient take or was the patient exposed to the substance?

Has the patient or a bystander performed any intervention on the patient? Have is helped?

How much does the patient weigh?

Alcohol

CNS depressant, a sedative, and a hypnotic

Patient may experience respiratory distress from CNS depression

Causes vomiting (emesis) that may be forceful or blood

Sedative

Decreases activity and excitement

Hypnotic

Induces sleep

Emesis

Vomiting

What may a patient who is going through alcohol withdrawal experience?

Frightening hallucinations (delirium tremens (DT))

What signs should you look for to suggest alcohol withdrawal?

Agitation and restlessness, fever, sweating, tremors, confusion or disorientation, delusions and hallucinations, seizures

Opioids

Acts as a CNS depressant, and produces insensibility or stupor

Signs of symptoms that a patient has taken an opioid

Seizures, nausea, vomiting, appear sedated or unconscious, exhibit cyanosis, have pinpoint pupils

What are the two types of sedative-hypnotic drugs?

Barbiturates and benzodiazepines

Appear drowsy, peaceful, or drunk

Have marked respiratory depression or may be in a choma

What class of drug is a club drug considered?

Sedative hypnotic

What do inhalant drugs do to the body?

Cause seizures, cause asphyxia

Halogenated hydrocarbon solvents can make the heart hyper-sensitive to a patient’s own adrenaline, making them at a high risk for cardiac death because of ventricular fibrillation

What is hydrogen sulfide and what does it do?

High toxic, colorless, flammable gas that smells like rotten eggs

Causes nausea, vomiting, confusion, dyspnea, loss of consciousness, seizures, shock, coma, and cardiopulmonary arrest

What are sympathomimetics and what do they do?

CNS stimulants that mimic sympathetic (fight or flight) nervous system

Cause hypertension, tachycardia, and dilated pupils, are a feel good drug, increase bp

Example: Coke, ectasy, molly, meth, uppers

What are synthetic cathinones and what do they do?

Bath salts ex.) Ivory wave and cloud 9

Produce euphoria, increased mental clarity, and sexual arousal

Effects last as long as 48 hours

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

What is cannabinoid hyperemesis syndrom?

Extreme nausea and vomiting relieved only by a hot shower or baths caused by chronic marijuana use

What is synthetic marijuana and what does it do?

“Spice”

Herbal incense or smoking blends that resemble THC and produce a similar high

What are hallucinogens and what do they do?

Alters a person’s sensory perceptions

Ex: LSD, PCP

Causes hypertension, tachycardia, anxiety, and paranoia

What do anticholinergic agents and what do they do?

Medications that block that parasympathetic nerves

“hot as a hare, blind as a bat, dry as a bone, red as a beet, mad as a hatter”

Ex: Benadryl, jimsonweed, elavil

What are cholinergic agents and what do they do?

Medications that overstimulate the normal body functions controlled by the parasympathetic nervous system

DUMBELS

• D: Diarrhea

• U: Urination

• M: Miosis (contracted pupils) muscle weakness

• B: Bradycardia, bronchospasm, bronchorrhea (discharge of excessive mucus of the lungs)

• E: Emesis (vomiting)

• L: Lacrimation (excessive tearing of the eyes)

• S: Seizures, salivation, sweating

What does salmonella bacterium do to the body?

72 hours of ingestion, including nausea, vomiting, abdominal pain, and diarrhea

What does staphylococcal do to the body?

Sudden gastrointestinal symptoms, including nausea, vomiting, and diarrhea

Starts within 2 to 3 hours or as long as 8 to 12 hours after ingestion

What does botulism or clostridium do?

Stems from improperly canned food, produces a toxin

Can develop as long as 4 days after ingestion or as early as the first 24 hours

Plant poisoning protocol

1. Assess the patient’s airway and vital signs

2. Notify regional poison center for assistance in identifying plant

3. Take the plant to the ED, or at least a picture

4. Transport promptly

When older patients take multiple prescriptions that may negatively interfere with each other, what is it called?

Polypharmacy

After primary assessment, what other questions should you ask in relation to pediatric patients?

What is the substance involved?

Approx how much of the substance was ingested or involved in the exposure?

What time did the incident occur?

Are there any changes in behavior or level of consciousness?

Was there any choking or coughing after the exposure?