Specific Poisons

• CNS depressant

• Sedative - decreases activity

• Hypnotic - induces sleep

• Dulls the senses, slows reflexes

Alcohol: Actions

delirium tremens (DTs)

Severe withdrawal syndrome in alcoholics including hallucinations

• Restlessness, agitation, confusion/disorientation

• Delusions, hallucinations

• Fever, sweating

• Tremors, seizures

S/sx of delirium tremens

Narcotic = produces sleep/altered mental status

Sedative = decreases activity/excitement

Hypnotic = induces sleep

Narcotic vs sedative vs hypnotic

• CNS depressant

• Narcotic

• Relieves pain

Opioids: actions

• Butorphanol (Stadol)

• Codeine

• Fentanyl (Sublimaze)

• Heroin

• Hydrocodone (Vicodin)

• Hydromorphone (Dilaudid)

• Morphine

• Methadone (Dolophine)

• Oxycodone hydrochloride (OxyContin)

• Oxymorphone (Opana)

Common opioids and opiates

• Nausea —> lead to hypotension

• Respiratory depression

• Sedated, unconscious

• Cyanosis

• Pinpoint pupils

S/sx opioids

• Naloxone (Narcan) - only used when the pt has agonal respirations or apnea

• OPA or NPA and ventilate w/ BVM before giving Narcan

Tx opioid overdose

• CNS depressant

• ALOC

• Drowsy, intoxicated

Sedative-hypnotic drugs actions

• Amobarbital (Amytal)

• Butabarbital (Butisol)

• Pentobarbital (nembutal)

• Phenobarbital (Luminal)

• Secobarbital (Seconal)

Examples of barbiturates

• Alprazolam (Xanax)

• Chlordiazepoxide (Librium)

• Diazepam (Valium)

• Flunitrazepam (Rohypnol)

• Lorazepam (Ativan)

• Oxazepam (Serax)

• Temazepam (Restoril)

Examples of benzodiazepines

• Chloral hydrate - Mickey Finn

• Rohypnol - roofies

• Ketamine - Ketalar or Special K

Date rape drugs (sedative-hypnotic)

• Keep airway open

• Assist ventilation, O2 therapy

Sedative-hypnotic tx

Briefly displace O2 in the brain and cause a rush of euphoria

Inhalants action

• Acetone, toluene, xylene, hexane - glues, cleaning compounds, paint thinners, lacquers

• Gasoline, halogenated hydrocarbons (Freon, difluoroethane)

Examples of abused inhalants

• Drowsiness

• coma

• Seizures

S/sx inhalant abuse

Makes the heart hypersensitive to adrenaline - high risk for sudden cardiac death because of ventricular fibrillation

Halogenated hydrocarbon cardiac risk

Hydrogen sulfide

Highly toxic, colorless, flammable gas, rotten-egg odor. Naturally in sewers, swamps, volcanoes, crude petroleum, fires. Used for suicide. Most impact on lungs/CNS

• Nausea, vomiting, confusion, dyspnea, LOC

• Seizures

• Shock

• Coma

• Cardiopulmonary arrest

S/sx of hydrogen sulfide use

Sympathomimetics

CNS stimulants - mimic fight or flight nervous system. Opposite of opioids and alcohol. Used to improve task performance, suppress appetite, prevent sleepiness

• Hypertension

• Tachycardia

• Dilated pupils

• Irritability, anxiety, lack of concentration, paranoia, delusions

• Seizures

S/sx sympathomimetics

• Amphetamine/methamphetamine (meth)

• Cocaine

• MDMA - ectasy/Molly

• Phentermine hydrochloride - appetite suppressant

• Amphetamine sulfate (Benzedrine) - wt control, narcolepsy, chronic fatigue syndrome

• Mild: caffeine, phenylpropanolamine (nasal decongestant)

Examples of sympathomimetics

• Inhaled: absorbed through the nasal mucosa, damaging tissue, causing nosebleeds, destroying nasal septum.

• Smoked: crack (pure cocaine) melted & vaporized - reaches the capillary network of the lungs, absorbed into the body. Outflow of blood from the heart speeds the drug to the brain (effects felt in seconds)

Cocaine complications

Seizures, cardiac dysrhythmias, stroke. Hallucinations - cocaine bugs (bugs crawling on their skin). 

Acute cocaine overdose s/sx

Euphoria, increased mental clarity, sexual arousal

Bath salts actions

teeth grinding, appetite loss, muscle twitching, lip-smacking, confusion, GI conditions, paranoia, headache, elevated HR, hallucinations

Adverse effects of bath salts

• Euphoria

• Relaxation, drowsiness

• Impairs short-term memory, complex thinking

Marijuana actions

• Jimsonweed

• DXM

• DMT

• Ketamine

• LSD

• PCP - angel dust

Common hallucinogens

• Visual hallucinations

• Intensify vision/hearing

• Separate user from reality

Hallucinogen actions

• Block parasympathetic nerves

• Hot as a hare - hyperthermia

• Blind as a bat - dilated pupils

• Dry as a bone - dry skin/mucous membranes

• Red as a beet

• Mad as a hatter - delirium

Anticholinergics action

• Atropine

• Antihistamines - Benadryl

• Jimsonweed

• Tricyclic antidepressants - cause cardiac dysrhythmias, seizures

Anticholinergic examples

• Overstimulate parasympathetic nervous system

• Organophosphates

• S/sx: DUMBELS

Cholinergic agents actions

• Nausea/vomiting

• Hyperventilation, tachypnea, hyperthermia

• Ringing ears

• Risk of seizures

Aspirin overdose s/sx

• Tachypnea

• Blindness (methyl)

• Renal failure (ethylene)

Alcohol overdose (methyl and ethylene)

Salmonella

S/sx: nausea/vomiting, abdominal pain, diarrhea, fever, generalized weakness

Organism in food that produces the direct effects of food poisoning

Staphylococcus

Grows in foods kept too long

S/sx: nausea/vomiting, diarrhea

Example of bacteria that produces toxins in leftover food

• Often fatal - from improperly canned food

• Neurologic s/sx: blurred vision, weakness, difficulty speaking/breathing, muscle paralysis

Botulism

1. Assess airway/vitals

2. Notify regional poison center

3. Take plant to ED

4. Prompt transport

Steps for plant poisoning