Ch 14 - Poisoning

poison def

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

poisoning def

sudden illness brought on by external substances entering the body (mild irritation → death)

poison facts (3)

• affects 50% children <6yo

• solid, liquid or gas

• common cause = carbon monoxide

most common poisons for children (4)

• cough/cold medicines

• pain & fever medicine

• cleaning solutions

• plants

poisoning ingestions on the rise (3)

• e-cigarettes

• vaping

• juul

entry route types (4)

• ingestion

• inhalaion

• absorption

• injection

ingestion

swallowed and enter body through digestive system

(hosuehold cleaners, pesticides etc)

inhalation

breathes in toxic gas or fumes

(gases, sprays, ammonia chloride)

absorption

enters body through the skin and body tissues

(corrosive chemicals, plant oils)

injection

enters through bites, stings or hypodermic syringes

(insects, spiders, snakes)

S/Sx poisoning - scene (4)

• odors

• flames/smoke

• open/empty/spilled out of place containers

• overtured / damaged plants

S/Sx poisoning - patient (8)

• nausea / vomiting

• chest / abdominal pain

• breathing difficulty

• altered LOR

• seizures

• burns on / around mouth

• diarrhea

• rash

what to do when someone has been poisoned

remove casualty from source, call 911 and ask for poison control centre and follow their directions

questions to ask if pt has been poisoned (4)

what type of poison was it?

how did the contamination occur?

when did it occur?

do you know the quantity of the poison?

S/Sx for ingestion poisoning (7)

• open container of poison nearby

• burns around mouth

• unusual odor of breath

• inc production of saliva

• burning sensation in mouth/throat/stomach 

• dizziness or drowsiness 

• unresponsiveness

poison - ingested (3)

• food poisoning 1 example

poison control may ask:

• induce vomiting

• use activated charcoal

• give pt water to drink

if poison control asks to induce vomiting make sure (4)

• fully responsive and understands instructions

• pt is co-operative

• pt has not had a seizure or vomited simultaneously 

• pt not exhibiting abnormal pulse, resp or LOR

S/Sx for inhaled poisoning (7)

• resp distress/arrest/dyspnea

• irritated eye nose throat

• dizziness

• vomiting

• seizures

• cyanosis around mouth

• unusual smell in air / on pt breath

poison - inhaled 

• if poison in air scene is not safe

• perform interventions req for resp arrest/distress and place in RTD

carbon monoxide poisoning (3)

• CO is odourless, colourless and tasteless

• found in fumes that are produced when fuel is burning in cars, trucks, stoves etc

• typical S/Sx of hypoxia

poison - absorbed BC focused ones (4)

• poison ivy

• poison sumac

• poison oak

• dry and wet chemicals

S/Sx for rash-causing plants for absorbed poisons (4)

• itching

• red rash

• swelling

• bumps, streaking and weeping blisters 

Tx for rash causing plants (3)

• cream or ointment to reduce itching (i.e calamine)

• pt take an oral antihistamine to relieve itching

• pt should be assessed by physician

if exposed to wet or dry chems

refer to care for chemical burns

poison - injected

• animal stings and bites most common

• do not capture animal make note of memorable features

poisoning - injected: stingers

• rarely fatal unless person is allergic

• examine to see if stinger is still embedded

• scrap away

• wash site w water and cover w a dressing and cold pack

poisoning - injected: spiders (2)

• black widow

• brown recluse 

S/Sx of black widow spider bite (6)

• raised round red mark

• cramping in thighs shoulders and back ad ms

• restless and anxiety

• dizziness

• headache

• excessive sweating

S/Sx of brown recluse spider bite (3)

• slight stinging sensation

• blood filled blister appearing within 2-8h

• bulls eye pattern around bite

Tx for non-venoumous spider

wash the wound and apply a cold pack to site

poisoning - injected: snakes (3)

• rattlesnacks most deadly in canada

• treat all snakebites as venomous

• 3 in canada

  • northern pacific rattlesnake

  • massasauga rattlesnake

  • prairie rattlesnake

poisoning - injected: snakes Tx (5)

• place in RTD, call ems and poison control

• keep injured site still, position so bite is @ or below level of heart if possible

• if bite on limb = remove jewelry and tight clothing

• wash wound w water

• cover bite w clean, steril, dry dressing

what are the most common and misused substances resulting in poisoning

alcohol and over the counter medications

drug def

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

medication def

drug used to prevent or treat a disease or condition

substance misue & abuse categories (3)

• stimulants

• depressants

• hallucinogens

stimulants (3)

• alter CNS by speeding up physicial and mental activity

• most are ingested

• produce temp feelings of alertness, improve task performance and prevent sleepiness

stimulant examples

• asthma medications

• cocaine

• crack

• caffeine

• chocolate

• nicotine 

stimulants misuse and abuse unhealthy effects

sweating

chills

nausea

vomiting

fever

headache

tachycardia

high BP

chest pain

hallucinogens (4)

• no medicinal purpose

• cause changes in mood sensation, thought, emotion and self-awareness

• mind-altering effects

• person may be irrational and feel threatened by any attempt to help

hallucinogens examples

lysergic acid

psilocybin (mushrooms)

phencylidine (angel dust)

depressants (3)

• affect the CNS and slow down physical and mental activity

• common medical purposes

• all alter awareness to some degree

depressant affects

• relieve anxiety

• promote sleep

• depress resps

• relieve pain

• relax muscules

• impair coorindation and judgement

depressant examples

• alcohol

• narcotics

• opiods 

opioids

class of depressants that include:

• morphine

• heroin

• fentanyl

why can opioids be so dangerous

high risk of fatal overdose due to high quantities and bind to receptors in brain that control respiration

opioid S/Sx (8)

• reduced LOR

• constricted pupils or rolled back eyes

• limp ms

• slow/absent pulse

• slow/absent resps

• low SpO2

• cold, pale or blue skin (esp lips and nail beds)

• vomiting

risks for opioid poisoning (4)

• mixing w other drugs

• change in tolerance or health

• previous experience w non-fatal opiod poisonings

• variation in strength content of supplier of “street” drugs

scene assessment - opioids (5)

any drug paraphernalia (needles)

bystanders under influence

infectious bodily fluids

crime scenes

opioid sources

naloxone

drug that rapidly counteracts affects of opioid overdose by binding same receptors in brain and displace

naloxone can be admin (3)

intranasally

intramuscularly

subcutaneously

naloxone has

NO effect on individ who is not suffering from opioid overdose

opioid overdose Tx (2)

• if person not breathing or agonal resp start compression only CPR

• naloxone may be re-admin every 3-5 min if no improvement in condition 

transfer of care if naloxone admin (4)

• time admin

• how it was admin (route)

• how much admin (dose)

• changes to person’s condition

designer drugs

manufactured or modified from other drugs or other common household products

NO medicinal purpose

general care for substance abuse and misuse (5)

• don’t pass judgement

• follow same protocol care (do not need to know specific substance taken)

• gain info from bystanders

• be in contact w ems and poison control

• be careful if someone is irritated, aggressive, violent or withdrawn